广州医科大学学报

目的：探讨血清视黄醇结合蛋白（RBP）、α1微球蛋白（α1-MG）和尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、尿微量白蛋白（U-mAlb）联合检测对急性肾损伤的诊断价值。方法：选择2021年1月至2022年12月来我院进行治疗的急性肾损伤（AKI）患者116例作为研究对象。根据AKI分期标准，将患者分为AKI 1期（研究组A 40例），AKI 2期（研究组B 39例）及AKI 3期（研究组C 37例）。并选择同期来我院体检的健康者116例作为对照组。比较研究组与对照组患者的血清RBP、α1-MG和尿NGAL、U-mAlb水平的差异，不同疾病分期患者血清RBP、α1-MG和尿NGAL、U-mAlb水平的差异，以及四种指标单独检测及联合检测的诊断效能。结果：研究组患者血清RBP、α1-MG和尿NGAL、U-mAlb水平均显著高于对照组（P<0.05），差异具有统计学意义；不同功能分期AKI患者血清RBP、α1-MG和尿NGAL、U-mAlb水平差异具有统计学意义（P<0.05）;Spearman相关性分析显示，RBP、α1-MG、NGAL及U-mAlb水平与AKI病情呈正相关；联合诊断较RBP、α1-MG、NGAL及U-mAlb单项检测，灵敏度降低，特异度提高，阳性预测值增加，阴性预测值降低，准确度提高，降低误诊率。结论：AKI患者血清RBP、α1-MG和尿NGAL、U-mAlb水平与肾损伤呈正相关，且四项指标联合检测能够有效提高诊断的准确度，降低AKI的误诊率。

Objective:To investigate the value of combined testing for serum retinol binding protein(RBP)andα1 microglobulin(α1-MG),urine neutrophil gelatinase-associated lipocalin(NGAL)and microalbumin(U-mAlb)in diagnosing acute kidney injury(AKI).Methods:A total of 116 patients with AKI who sought treatment in our hospital between January 2021 and December 2022 were included as study subjects. According to the criteria of AKI staging,there were 40 patients with stage 1 AKI(study group A),39 with stage 2 AKI(study group B)and 37 with stage 3 AKI(study group C). A contemporary cohort of 116 health checkup subjects in our hospital were included as the control group. The differences in serum RBP,α1-MG,urine NGAL and U-mAlb levels were compared between the study groups and the control group. The differences in serum RBP,α1-MG,urine NGAL and U-mAlb levels were also compared across patients with different AKI staging. The diagnostic performance of these four indicators in AKI,tested alone or in combination,was analyzed.Results:The levels of serum RBP and α1-MG,urine NGAL and U-mAlb in the study group were significantly higher than those in the control group,with statistically significant difference(P<0.05).The levels of serum RBP and α1-MG,urine NGAL and U-mAlb also varied statistically across patients with different AKI staging(P<0.05). Spearman correlation analysis showed that the levels of RBP,α1-MG,NGAL and U-mAlb were positively correlated with the severity of AKI. Compared with testing of each alone,combined testing for RBP,α1-MG,NGAL and U-mAlb resulted in lower sensitivity,higher specificity and positive predictive value,lower negative predictive value,higher accuracy,and lower rate of misdiagnosis.Conclusion:Serum RBP and α1-MG,urine NGAL and U-mAlb levels in AKI patients positively correlate with renal injury. Combined testing for these four indicators can effectively improve diagnostic accuracy and reduce misdiagnosis for AKI.