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目的探讨尿Na~+/H~+交换体亚型3(Sodium Hydrogen exchanger isoform 3,NHE3)在重症监护(ICU)患者急性肾损伤(acute renal injury,AKI)早期诊断中的价值。方法前瞻性选择入住ICU的100例患者,每天收集血、尿标本,用酶法测定血清肌酐(Scr),ELISA法测定尿NHE3水平,计算肾小球滤过率(GFR),根据有无合并AKI将患者分成AKI组和非AKI组,并与30例健康体检者作为正常对照组进行比较。采用ROC曲线评价尿NHE3诊断AKI的临床价值。结果三组尿NHE3基线水平无明显差异,非AKI组Scr、GFR、尿NHE3水平无明显变化,AKI组尿NHE3水平显著升高,升高时间较Scr提前24 h。尿NHE3与Scr呈正相关、与GFR呈负相关(r=0.457,-0.463,P均<0.05)。以Scr升高>50%或血肌酐升高绝对值≥26.4μmol/L作为AKI的诊断标准,NHE3灵敏度和特异度绘制ROC曲线,曲线下面积(AUC)为0.758,与完全随机情况下获得的AUC=0.5差异有统计学意义(P<0.05)。以NHE3升高>50%基础值作为AKI的诊断界限时,敏感度和特异度分别为67.9%和88.9%,阳性预测值和阴性预测值分别为70.4%和87.7%。结论尿NHE3表达较Scr更早发生变化,可作为ICU患者AKI早期预测指标。
Objective To investigate the value of urine Na + / H + exchanger 3 (NHE3) in the early diagnosis of acute renal injury (AKI) in intensive care unit (ICU) patients. Methods A total of 100 ICU patients were selected prospectively. Blood and urine samples were collected daily. Serum creatinine (Scr) was measured enzymatically. Urinary NHE3 levels were measured by ELISA. Glomerular filtration rate (GFR) was calculated. AKI patients were divided into AKI group and non-AKI group, and 30 healthy subjects were compared as a normal control group. The clinical value of urine NHE3 in the diagnosis of AKI by ROC curve. Results There was no significant difference in baseline levels of NHE3 among the three groups. The levels of Scr, GFR and urine NHE3 in non-AKI group had no significant changes. Urinary NHE3 level increased significantly in AKI group and increased 24 hours earlier than Scr. Urinary NHE3 was positively correlated with Scr and negatively correlated with GFR (r = 0.457, -0.463, P <0.05). The ROC curve was plotted with an increase in Scr> 50% or an absolute increase in serum creatinine> 26.4 μmol / L as the diagnostic criteria for AKI. The area under the curve (AUC) was 0.758 for NHE3 sensitivity and specificity. AUC = 0.5 difference was statistically significant (P <0.05). The sensitivity and specificity of NHE3 increased> 50% basal value as the diagnostic limit of AKI were 67.9% and 88.9%, respectively. The positive predictive value and negative predictive value were 70.4% and 87.7% respectively. Conclusions Urinary NHE3 expression changes earlier than Scr, which can be used as an index of early prognosis in patients with ICU.