Lub luag hauj lwm ntawm Urinary raum Stress Biomarkers Rau Thaum Ntxov Paub Txog Subclinical Acute raum Injury hauv Critically Ill COVID-19 Cov Neeg Mob Ⅲ
Apr 23, 2024
4. Kev sib tham
Thaum nkag mus hauv tsev kho mob, feem ntau ntawm cov neeg mob muaj cov tsos mob ntawm subclinicallub raum tsis ua haujlwmuas tseem tsis tauua AKI. Nyob rau hnub tom ntej, AKI tau dhau los ua ib qho teeb meem hauv peb cov neeg mob, cuam tshuam 49% thaum mus pw hauv tsev kho mob. Qhov zaus no tau zoo ib yam li qhov uas tau pom hauv cov kev tshawb fawb yav dhau los, qhia txog AKI hauv 50% ntawm cov neeg mob nrog COVID-19 hauv ICU [2]. Peb pom tias [TIMP-2] × [IGFBP7] Ntau dua lossis sib npaug rau 0.2 (ng/mL)2/1000 yog qhov muaj feem pheej hmoo rau AKI. Tsis tas li ntawd, kev soj ntsuam kev ciaj sia tau qhia tias lub sijhawm rau AKI tau luv luv rau cov tib neeg uas siab dua [TIMP-2] × [IGFBP7]. Rau peb txoj kev paub, ob peb txoj kev tshawb fawb tau tshuaj xyuas qhov ua tau zoo ntawm biomarkers rau kev kwv yees ntawm AKI pib hauv cov neeg mob hnyav nrog COVID-19. Ib txoj kev tshawb fawb me me tau tshaj tawm tias cov neeg mob uas muaj tus kab mob COVID{13}} koom nrog AKI thiab qib siab ntawm [TIMP-2] × [IGFBP7] muaj feem cuam tshuam rau kev kho lub raum hloov ntau dua li cov neeg mob AKI tab sis nrog qis [TIMP{ {16}}] × [IGFBP7] [16]. Peb qhov kev tshawb pom tau ua raws li cov ntaub ntawv dhau los, piav qhia txog qib siab ntawm [TIMP-2] × [IGFBP7] raws li kev kwv yees ntawm cov txiaj ntsig tsis zoo hauv ntau yam kev kho mob, xws li kev tuag, kev lim ntshav, lossis kev nce mus rau AKI hnyav hauv cov neeg mob septic shock. [17]; AKI hauv cov neeg mob tom qab kev phais loj [18]; kev pheej hmoo ntawm AKI hauv cov neeg mob hnyav [7]; thiab AKI hauv platinum-kho cov neeg mob ntawm ICU [19]. Lub mechanism uas tau npaj tseg yog tom qab ntawdpib kev puas tsuaj, IGFBP7 thiab TIMP-2 yog qhia nyob rau hauv tubular hlwb. IGFBP7 ncaj qha nce qhov kev qhia ntawm p53 thiab p21, thiab TIMP-2 txhawb nqa p27 qhia, ua rau kev hloov pauv ntawm G1 cell voj voog ntes, tiv thaiv kev faib tawm ntawm cov hlwb puas [5]. Yog li, txij li G1 cell voj voog raug ntes yog ib qho lus teb rau kev puas tsuaj ntawm tubular, cov biomarkers yuav zoo dua cuam tshuam txog kev puas tsuaj tsis hais txog etiology. TIMP-2 yog ob qho tib si nthuav tawm thiab zais qhov tshwj xeeb los ntawm cov hlwb ntawm cov tubules distal, thaum IGFBP7 yog sib npaug sib npaug ntawm cov tubule cell hom tseem nyiam tshaj tawm los ntawm cov hlwb ntawm cov tubule keeb kwm. Nyob rau hauv tib neeg lub raum cov ntaub so ntswg, muaj zog staining ntawm IGFBP7 tau pom nyob rau hauv lub luminal txhuam ciam teb cheeb tsam ntawm ib tug subset ntawm proximal tubule hlwb, thiab TIMP{13}} stained intracellularly nyob rau hauv distal tubules [20]. AKI-induced urinary [TIMP-2] × [IGFBP7] kuj tau raug ntaus nqi rau kev pom ntau ntxiv, txo cov tubule reabsorption, thiab proximal tubule cell urinary to ntawm ob qho tib si molecules [21].
Nws yuav siv sij hawm ntev npaum li cas rau CISTANCHE ua haujlwm?
Kev sib xyaw ua ke ntawm [TIMP-2] × [IGFBP7] muaj qhov ua tau zoo tshaj plaws rauAKI twv ua ntejntawm tus nqi saum toj no 0.2 (ng/mL)2/1000. Qhov kev txiav tawm no yog ua raws li tus cwj pwm tag nrho ntawm biomarkers hauv cov neeg mob uas tau kawm ntawm no. Txawm li cas los xij, qhov kev txiav tawm sib txawv rau cov biomarkers no tau tshaj tawm hauv lwm cov kev tshawb fawb, yog li cov pab pawg tshwj xeeb ntawm cov neeg mob yuav xav tau kev txheeb xyuas cov txiaj ntsig zoo txiav tawm raws li lawv cov txiaj ntsig ntawm AUC, rhiab heev, tshwj xeeb, PPV, NPV, thiab raug. Cov nqi txiav tawm yuav raug cuam tshuam los ntawm qhov hnyav ntawm AKI. Ntawd yog, kev txiav tawm ntau dua tuaj yeem pom hauv cov neeg mob AKItheem 2 thiab 3, thiab kev txiav qis qis tuaj yeem pom hauv cov neeg mob nrogAKI theem 1los yogsubclinical AKI.Ntxiv mus, AKI yog ib tug complex syndrome uas muaj ib tug series ntawm complex cellular thiab molecular txoj kev, thiab qhov sib txawv cutoffs tej zaum yuav muaj kev cuam tshuam mechanistic sib txawv ntawm ntau yam etiologies ntawm AKI [5]. Cov txheej txheem pathophysiologic ntawm AKI hauv COVID-19 tau xav tias yuav muaj ntau yam suav nrog kev tiv thaiv kab mob thiab cov lus teb inflammatory uas raug ntxias los ntawm tus kab mob kis, cov ntaub so ntswg hypoxia, txo lub raum perfusion, endothelial puas tsuaj, thiab ncaj qha mus rau epithelial kis nrog SARS-CoV. -2 [22].
Hauv peb pawg, lub sijhawm rau AKI tau luv luv rau cov tib neeg uas muaj NGAL Ntau dua lossis sib npaug li 45 ng / mL dua li cov neeg uas muaj NGAL.<45 ng/mL, but NGAL was not a risk factor for AKI during hospitalization. The fact that the performance of NGAL was significantly better on day 7 than during the whole hospitalization period, suggests that NGAL has a narrow predictive time window for AKI, and that may explain why it was not a risk factor for AKI during the whole hospitalization. In addition, NGAL has proved to be less discriminating in the development of septic-associated or adult cardiac-surgery-associated AKI than in other types of AKI, possibly because neutrophils themselves may be a source of NGAL in the setting of systemic inflammation [23].
Tsis zoo li peb qhov kev tshawb pom, kev tshawb fawb tsis ntev los no tau pom tias tso zis NGAL> 150 ng / mL kwv yees qhov kev kuaj mob, lub sijhawm, thiab qhov hnyav ntawm AKI thiab mob tubular raug mob, nrog rau kev nyob hauv tsev kho mob, lim ntshav, poob siab, thiab kev tuag ntawm cov neeg mob uas mob hnyav. -19 [24]. Cov txiaj ntsig sib txawv tuaj yeem piav qhia los ntawm qhov tseeb tias qee tus neeg mob hauv qhov kev tshawb fawb no tej zaum yuav muaj AKI thaum kuaj zis, thaum peb tsuas suav nrog cov neeg mob uas tsis muaj AKI thaum lub sijhawm sau cov zis. Yog li ntawd, tus nqi nruab nrab ntawm NGAL hauv AKI pab pawg (50.2 ng / mL) thiab cov kev xaiv txiav tawm (45 ng / mL), tau qis dua hauv peb cov neeg mob vim lawv muaj subclinical AKI. Tsis tas li ntawd, nws tsis paub meej yog tias feem ntau ntawm lawv cov neeg mob muaj AKI theem 2 thiab theem 3, thaum peb cov neeg mob feem ntau tsim AKI theem 1 rau hnub tom ntej. Qhov no tseem ceeb vim tias txoj kev tshawb fawb no kuj tau tshaj tawm txog kev sib raug zoo ntawm cov zis NGAL thiab AKI qhov hnyav. Hauv lwm txoj kev tshawb fawb tsis ntev los no, NGAL kuj tau pom tias yog qhov muaj kev pheej hmoo ywj pheej rau AKI hauv cov neeg mob uas muaj COVID-19, tab sis txoj kev tshawb no kuj suav nrog qee cov neeg mob uas twb muaj AKI thaum kuaj zis [25]. Yog li, peb xav tias nyob rau hauv cov neeg mob nrog COVID{11}}, siab dua NGAL txiav tawm qhov txiaj ntsig zoo li muaj txiaj ntsig zoo hauv kev kwv yees kev nce qib AKI tab sis tsis yog AKI pib. Txawm li cas los xij, txij li tus naj npawb ntawm cov neeg mob hauv peb txoj kev tshawb fawb tseem tsawg, peb yuav tsis tso tseg qhov muaj peev xwm kwv yees tus nqi ntawm NGAL uas tej zaum yuav raug nthuav tawm los ntawm kev ntxiv cov neeg mob ntxiv. Txawm hais tias qhov kev txiav tawm qhov tseem ceeb, peb qhov kev tshawb pom tau ua raws li kev tshawb fawb uas tau tshaj tawm ntau dua NGAL qib hauv cov neeg mob nrog COVID-19 yam tsis muaj pov thawj ntawm AKI ntawm kev nthuav qhia uas tom qab tsim AKI theem 1 txog 3 hauv xya hnub ntawm kev nkag, piv nrog cov uas tsis tsim AKI [26]. Hauv qhov sib piv nrog peb qhov kev tshawb pom, cov zis NGAL, tab sis tsis yog [TIMP-2] × [IGFBP7], nws tus kheej kwv yees AKI nyob rau hauv ib pawg ntawm cov neeg mob ntshav qab zib decompensated, qhia tias cov biomarkers sib txawv yuav tsum tau siv hauv ntau pawg neeg mob [27] .
Kev soj ntsuam kev ciaj sia tau qhia tias kev tuag ntau zaus hauv cov neeg mob uas tau tsim AKI tsis tu ncua thaum mus pw hauv tsev kho mob. Lub tswv yim hais tias lub sij hawm yuav tsum tau txiav txim siab nyob rau hauv cov lus piav qhia ntawm AKI thiab tsis tsuas yog qhov hnyav tau tshwm sim nyob rau hauv kev tshawb fawb qhia tias lub sij hawm ntawm AKI tom qab kev phais nws tus kheej cuam tshuam nrog kev tuag hauv tsev kho mob tom qab kho qhov mob hnyav [28]. Transient AKI tuaj yeem cuam tshuam txog kev txo qis hauv lub raum ua haujlwm tsis muaj kev puas tsuaj rau lub raum, qhov tsis tu ncua AKI yuav cuam tshuam cov qauv tubular puas tsuaj [29]. Raws li cov kev soj ntsuam no, AKI tsis tu ncua tau dhau los ua qhov tseem ceeb hauv cov kev tshawb fawb tom ntej thiab nws tau cuam tshuam nrog kev tuag [30].
Txij li thaum peb tau kawm cov neeg mob uas muaj lub raum ua haujlwm ntawm lub hauv paus, cov lus xaus ntawm txoj kev tshawb no yuav tsis siv tau rau cov neeg mob uas mob raum ua haujlwm tsis zoo. Qhov no yog, hmoov tsis, qhov tsis zoo ntawm lub raum biomarkers, uas muab kev kwv yees zoo heev ntawm kev hloov pauv AKI hauv cov neeg mob uas muaj lub raum tsis zoo tab sis muaj nqi tsawg rau cov neeg mob uas muaj kab mob hauv lub raum. Kev siv biomarkers muaj qee qhov kev txwv, thiab nws yuav tsum tau txiav txim siab tias lawv tus nqi rau kev kwv yees ntawm AKI tsuas yog txwv rau cov neeg mob uas mob hnyav. Thaum siv rau hauv cov neeg mob uas tsis tshua muaj kev pheej hmoo, tus nqi tsis zoo yuav nce ntxiv. Thaum siv ua ntej muaj kev raug mob tshwm sim, qhov kev sim yuav tsis kwv yees AKI. Ib yam li ntawd, qhov kev ntsuam xyuas yuav tsis zoo rau lub sijhawm ntev tom qab raug mob [3]. Yog tias tau txais txiaj ntsig zoo, qhov kev ntsuam xyuas yuav tsum tau txhais nrog rau lwm yam kev kho mob thiab kev sab laj nephrology yuav tsum tau txiav txim siab. Thaum siv tau zoo, biomarker-guided interventions muaj txiaj ntsig hauv kev tiv thaiv AKI. Qhov no tau tshwm sim hauv kev sim tshuaj suav nrog cov neeg mob uas muaj kev pheej hmoo siab, txhais tau tias tso zis [TIMP-2] × [IGFBP7] > 0.3 kev phais mob plawv. Hauv txoj kev tshawb no, kev siv KDIGO cov lus qhia, suav nrog kev ua kom zoo ntawm cov xwm txheej ntim thiab hemodynamics, kev zam ntawm cov tshuaj nephrotoxic, thiabtiv thaiv hyperglycemia, ua rau muaj kev pheej hmoo txo qis ntawm 16.6% hauv qhov xwm txheej ntawm AKI piv nrog cov qauv kev saib xyuas [31].
Ib qho kev txwv tseem ceeb ntawm peb txoj kev tshawb fawb yog tus qauv me me. Lwm qhov kev txwv tsis pub muaj yog cov neeg mob uas tsis tiav cov ntaub ntawv kho mob lossis cov neeg raug xa mus rau lwm lub tsev kho mob vim qhov tsis txaus ntawm ICU txaj tsis suav nrog hauv txoj kev tshawb no, thiab qhov no tuaj yeem sawv cev rau kev xaiv tsis ncaj ncees. Kev txiav txim siab tias tus qauv txhais ntawm AKI yog raws li sCr thiab cov zis tso zis [32], tom qab ntawd kev nkag mus tsis tau rau cov ntaub ntawv kho mob uas txwv rau COVID-19 thaj chaw sawv cev yog qhov kev txwv tseem ceeb vim tias cov zis tso zis tsis tau siv rau kev kuaj mob AKI. , thiab sCr tsis raug kho rau cov kua dej sib npaug. Nws tsim nyog yuav tsum tau hais tias ob pawg neeg muaj qhov zoo sib xws ntawm qhov nruab nrab ntawm lub hauv paus sCr, tab sis peb xav tias qhov sib txawv ntawm cov pab pawg yuav raug piav qhia los ntawm qhov tseeb tias hauv pawg AKI, sCr qhov tseem ceeb tau tawg ntau dua, qhov sib txawv ntawm qhov sib txawv tau dav dua, thiab cov neeg laus. Cov neeg mob uas muaj AKI muaj ntau dua urea, tab sis peb tsis tuaj yeem tshem tawm qhov ntim ntawm cov pab pawg no. Qhov tsis muaj qhov ntsuas hauv tsev kho mob ua ntej sCr kuj yog ib qho kev txwv kev kawm vim hais tias lub hauv paus sCr qhov tseem ceeb yog qhov kev kwv yees. Ib qho kev txwv ntxiv yog tias peb txoj kev tshawb fawb tau ua nyob rau hauv lub chaw xa mus rau lub teb chaws rau cov kab mob ua pa uas tau txais cov neeg mob tsis txaus ntseeg ntau dua uas muaj tus kab mob COVID-19, thiab qhov no yog qhov muaj peev xwm ntawm kev xa mus rau kev tsis ncaj ncees.
5. Cov lus xaus
Cov txiaj ntsig siab ntawm cov zis [TIMP-2] × [IGFBP7] yog qhov muaj feem cuam tshuam rau AKI thiab persis tent AKI yog qhov muaj feem cuam tshuam rau kev tuag. Cov biomarkers no, ua ke nrog cov ntaub ntawv kho mob, tau muaj txiaj ntsig zoo rau kev txheeb xyuas cov subclinical AKI hauv cov neeg mob hnyav COVID-19. Lub luag haujlwm ntawm biomarkers ntxiv thiab lawv cov kev sib txuas ua ke rau kev tshawb pom ntxov ntawm AKI hauv cov neeg mob hnyav COVID-19 tseem yuav tau tshawb nrhiav hauv kev sim tshuaj loj. Kev tiv thaiv ua rau AKI yuav tsum raug txo kom tsawg.
Sau Kev Koom Tes: Kev Ntseeg, GC-A.; methodology, LF-H.; software, RO-O.; val idation, MC-L.; kev soj ntsuam, IL-R.; kev tshawb nrhiav, NC-D.; cov peev txheej, AP-P.; data curation, MG-N.; kev sau ntawv-kev npaj ua ntej, CA-dlB thiab PF-C.; sau-saib thiab kho, CA-dlB; Visualization, DE-I., YL-V., EP-I., CA-dlB and S.Á.-R.; kev saib xyuas, PMDR-E.; kev tswj xyuas qhov project, GC-A.; kev nrhiav nyiaj txiag, S.A.-R. Txhua tus kws sau ntawv tau nyeem thiab pom zoo rau cov ntawv luam tawm ntawm cov ntawv sau. Kev Pab Nyiaj: Txoj haujlwm no tau txais kev txhawb nqa los ntawm cov nyiaj los ntawm Tsoomfwv Mev (Programa Presupuestal P016, Anexo 13 del Decreto del Presupuesto de Egresos de la Federación). Institutional Review Board Statement: Txoj kev tshawb no tau ua raws li cov lus qhia ntawm Kev Tshaj Tawm ntawm Helsinki, thiab tau pom zoo los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Tshawb Fawb ntawm Lub Tsev Haujlwm Saib Xyuas Kab Mob Hauv Lub Tebchaws (Kev Pom Zoo Tsis Muaj C26-20; 21 Tsib Hlis 2020). Cov Lus Qhia Txog Kev Pom Zoo: Cov ntaub ntawv pom zoo tau txais los ntawm txhua yam kev koom tes hauv txoj kev kawm. Cov Lus Qhia Txog Cov Ntaub Ntawv: Tag nrho cov ntaub ntawv tsim thiab tshuaj xyuas thaum lub sijhawm kawm no tau suav nrog hauv Cov Ntaub Ntawv Ntxiv (S1 File Raw Data). Kev tsis sib haum xeeb ntawm kev txaus siab: Cov neeg sau ntawv tshaj tawm tias tsis muaj kev tsis sib haum xeeb ntawm kev txaus siab
Cov ntaub ntawv
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