基质金属蛋白酶-9和胱抑素-C联合预测老年急性肾损伤的价值

Predictive value of matrix metalloproteinase-9 and cystatin-C for acute kidney injury in elderly patients

摘要:

目的 探讨血清基质金属蛋白酶-9(MMP-9)和胱抑素-C(Cys-C)预测老年急性肾损伤(AKI)的价值。方法 纳入山东省泰山疗养院医养结合病房2016年6月至2018年6月发生AKI患者116例为AKI组,同期未发生AKI患者68例为非AKI组,采集空腹外周静脉血,酶联免疫吸附法(ELISA)测定血清MMP-9和Cys-C水平,比较2组患者MMP-9和Cys-C水平。受试者工作特征(ROC)曲线分析MMP-9和Cys-C单独及联合预测AKI的价值。应用SPSS 20.0统计软件对数据进行分析。结果 相比非AKI组患者,AKI组MMP-9[(377.61±28.72)vs(96.50±20.42)ng/ml]和Cys-C[(3.22±0.76)vs(0.92±0.16)mg/L]水平明显增高,差异具有统计学意义(P＜0.05)。MMP-9预测AKI的ROC曲线下面积(AUC)为0.714,截断点190ng/ml时约登指数最大,灵敏度77%,特异度63%。Cys-C预测AKI的AUC为0.805,截断点2.0mg/L时约登指数最大,灵敏度80%,特异度75%。MMP-9和Cys-C联合预测AKI的AUC为0.856,灵敏度85%,特异度81%,显著大于各单项标志物,差异具有统计学意义(P＜0.05)。结论 老年AKI患者血MMP-9和Cys-C水平升高,MMP-9和Cys-C联合预测AKI的灵敏度和特异度较单项标志物高。

Abstract:

Objective To explore the value of serum matrix metalloproteinase-9 (MMP-9) and cystatin-C (Cys-C) in prediction of acute kidney injury (AKI) in the elderly. Methods A total of 116 AKI patients in our ward from June 2016 to June 2018 were enrolled as AKI group. Another 68 patients without AKI during the same period were subjected as non-AKI group. Fasting peripheral venous blood samples were collected to detect the serum levels of MMP-9 and Cys-C by enzyme-linked immunosorbent assay (ELISA). The levels were compared between 2 groups. Receiver operating characteristic (ROC) curve analysis was used to analyze the value of MMP-9 and Cys-C in predicting AKI individually and jointly. SPSS statistics 20.0 was used for data analysis. Results The serum levels of MMP-9 [(377.61±28.72) vs (96.50±20.42)ng/ml] and Cys-C [(3.22±0.76) vs (0.92±0.16)mg/L] were significantly higher in the AKI group than in the non-AKI group (P<0.05). The area under ROC curve (AUC) of MMP-9 in predicting AKI was 0.714, the Yoden index was the highest when the cut-off point was 190ng/ml, and the sensitivity and specificity were 77% and 63%, respectively. Cys-C predicted AKI with an AUC of 0.805 and cut-off point of 2.0mg/L, and the Yoden index was the highest with sensitivity of 80% and specificity of 75%. The AUC of AKI predicted by their combination was 0.856, sensitivity was 85%, and specificity was 81%, which was significantly higher than those of individual markers (P<0.05). Conclusion The serum levels of MMP-9 and Cys-C are elevated in elderly AKI patients. The sensitivity and specificity of combined prediction of AKI by MMP-9 and Cys-C are higher than those of single marker of MMP-9 or Cys-C.