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目的:研究尿液白细胞介素-18(IL-18)在慢性肾脏病基础上急性肾损伤(AonC)诊断中的应用价值。方法:入选住院的AonC患者(AonC组)、稳定的慢性肾脏疾病(CKD对照组)患者及体检中心无CKD的体检者(正常对照组)各28例,分别收集各组的临床、实验室检查资料及尿液标本;采用ELISA方法检测尿IL-18水平,用比色法检测尿N-乙酰-β-D氨基葡萄糖酐酶(NAG)水平,进行综合分析。结果:尿IL-18水平在AonC组、CKD对照组和正常对照组分别为343.10(230.76～721.78)ng/L、205.97(137.06～319.62)ng/L、44.44(12.42～107.19)ng/L。AonC组尿IL-18水平显著高于CKD对照组和正常对照组(P<0.01)。相关性分析显示,AonC组尿IL-18水平与血清肌酐水平呈正相关(r=0.665,P<0.01)。ROC曲线分析提示,尿IL-18在AonC诊断中特异性较高,曲线下面积为0.886,P<0.01;当以212.4ng/L为截点时,其在诊断AonC时的敏感性和特异性分别为85.7%和76.8%。3组患者尿液NAG水平亦存在统计学意义(P<0.01),但尿NAG水平与Scr无显著性相关。ROC曲线分析显示,曲线下面积为0.67。当检测的截点为10.5U/L时,其诊断的敏感性和特异性分别为74.1%和58.9%。结论:尿IL-18水平在慢性肾脏病基础上急性肾损伤时明显上升,在慢性肾脏病基础上急性肾损伤诊断中的意义值得进一步研究。
Objective: To investigate the value of urine interleukin-18 (IL-18) in the diagnosis of acute kidney injury (AonC) based on chronic kidney disease. Methods: AonC patients (AonC group), stable CKD patients (CKD control group) and 28 healthy controls without CKD (normal control group) were enrolled in this study. Clinical and laboratory tests Data and urine samples were collected. Urinary IL-18 levels were measured by ELISA. Urinary N-acetyl-β-D glucosaminidase (NAG) levels were measured by colorimetric method and analyzed comprehensively. Results: Urinary IL-18 levels were 343.10 (230.76 ~ 721.78) ng / L, 205.97 (137.06 ~ 319.62) ng / L and 44.44 (12.42 ~ 107.19) ng / L in AonC group, CKD control group and normal control group respectively. The level of urinary IL-18 in AonC group was significantly higher than CKD control group and normal control group (P <0.01). Correlation analysis showed that urinary IL-18 level in AonC group was positively correlated with serum creatinine (r = 0.665, P <0.01). ROC curve analysis showed that urinary IL-18 was highly specific in diagnosis of AonC. The area under the curve was 0.886, P <0.01. Sensitivity and specificity of urinary IL-18 when diagnosing AonC was 212.4ng / L Respectively 85.7% and 76.8%. There was also statistical significance in urinary NAG levels between the three groups (P <0.01), but there was no significant correlation between urinary NAG level and Scr. ROC curve analysis showed that the area under the curve was 0.67. The sensitivity and specificity of the diagnostic cutoff of 10.5 U / L were 74.1% and 58.9%, respectively. Conclusions: Urinary IL-18 levels are significantly increased in patients with acute renal injury on the basis of chronic kidney disease. The significance of the diagnosis of acute kidney injury on the basis of chronic kidney disease deserves further study.