Objective To assess the value of urine neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for early diagnosis of acute kidney injury (AKI) in patients with epidemic hemorrhagic fever (EHF).Methods The enrolled participants were 41 cases of EHF who received treatment in Department of Nephrology,ICU,Department of Respiratory Medicine,or Department of Haematology,Affiliated Hospital of Jining Medical University from January 2014 to November 2016 and met the inclusion and exclusion criteria of this study.Based on the diagnostic standard of AKI,patients with AKI symptoms were assigned to the AKI group and the others were assigned to the non-AKI group.Levels of Scr,urine NGAL and KIM-1 were measured at the time of diagnosis,2 h,4 h,8 h,12 h,24 h after diagnosis,respectively.The receiver operating characteristic (ROC) curve of urine NGAL and urine KIM-1 was used to evaluate their values for early diagnosis of AKI.Results Among the 41 cases of EHF,26 (63.4％) had concomitant AKI.At the time of diagnosis,the levels of Scr and urine KIM-1 were similar in both groups (P ＞ 0.05).Compared with the non-AKI group,AKI group had significantly increased Scr levels at 24 h,48 h,72 h after the diagnosis (P ＜ 0.05).The levels of urine NGAL varied significantly by the time of measurement in both groups (P ＜ 0.05).The levels of urine KIM-1 varied obviously by the time of measurement after diagnosis in both groups (P ＜ 0.05).Pearson's correlation analysis found that,the level of Scr measured at 24 h after diagnosis was positively correlated with that of urine KIM-1 measured at 2 h after diagnosis (r =0.673,P ＜ 0.01),and it presented a linear positive correlation with the level of urine NGAL measured at 2 h after diagnosis (r =0.846,P ＜0.01).The AUC of ROC curve of level of urine NGAL measured at 2 h after diagnosis for the prediction of EHF with AKI was 0.822 [95％ CI (0.692,0.952)] with a cutoff value of 40.15 pg/ml.For the prediction of EHF with AKI,the AUC of ROC curve of level of urine KIM-1 was 0.785 [95％ CI (0.643,0.927)] with a cutoff value of 0.55 pg/ml.Conclusion Urine NGAL and KIM-1 may be used as the markers for early diagnosis of EHF with AKI.%目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和肾损伤分子-1 (KIM-1)在流行性出血热(EHF)合并急性肾损伤(AKI)早期诊断中的价值.方法 选取2014年1月-2016年11月济宁医学院附属医院肾内科、ICU、呼吸科及血液科收治的符合纳入排除标准的41例EHF患者.根据AKI的诊断标准,将患者分为非AKI组和AKI组,收集两组确诊时、确诊后不同时间点的血清肌酐(Scr)、尿NGAL、尿KIM-1水平.采用受试者工作特征(ROC)曲线评价尿NGAL和尿KIM-1对EHF合并AKI的早期诊断价值.结果 41例EHF患者中,合并AKI者26例(63.4％).两组患者确诊时Scr、确诊时尿KIM-1水平比较,差异无统计学意义(P＞0.05);两组患者Scr水平在确诊后24、48、72 h比较,差异有统计学意义(P＜0.05);尿NGAL水平在确诊时及确诊后2、4、8、12、24h比较,差异有统计学意义(P＜0.05);尿KIM-1水平在确诊后2、4、8、12、24 h比较,差异有统计学意义(P＜0.05).Pearson相关分析显示,确诊后2h尿KIM-1水平、确诊后2h尿NGAL水平与确诊后24 h Scr水平呈正相关(r值分别为0.673、0.846,P＜0.01).确诊后2h尿NGAL诊断EHF合并AKI的ROC曲线下面积为0.822[95％ CI(0.692,0.952)],截点值为40.15 pg/ml;确诊后2h尿KIM-1的曲线下面积为0.785(95％ CI (0.643,0.927)],截点值为0.55 pg/ml.结论 尿NGAL和尿KIM-1可能可以作为EHF患者是否合并AKI的早期诊断标志物.
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