标题：尿海藻糖酶评估失血性休克患者肾功能损害的价值

      作者：严林，刘新锋，罗杰龙，修风民，李德亮    (东莞市塘厦医院外一区，广东 东莞 523718)

      卷次： 2018年29卷19期

      【摘要】 目的 探讨尿海藻糖酶评估失血性休克患者肾功能损害的临床价值。方法 选取 2016年 6月至2017年11月入住东莞市塘厦医院外一区且符合纳入和排除标准的患者为研究对象，以20例失血性休克患者为观察组，20例健康人为对照组，采用酶联免疫吸附法检测健康人以及失血性休克患者手术前、术后6 h、术后12 h、术后24 h血尿海藻糖酶的OD值，先画出标准曲线，再计算出各组的海藻糖酶含量，对比各组受检者的尿海藻糖酶含量，绘制受试者工作特征曲线(ROC曲线)，记录术中所见腹腔内总出血量。结果 对照组尿海藻糖酶的含量为(2.46±0.21) μmol/L，术前观察组患者尿海藻糖酶的含量为(3.70±0.44) μmol/L，术后 6 h为(4.16±0.78) μmol/L，术后12 h为(3.48±0.51) μmol/L，观察组患者尿海藻糖酶的含量分别与对照组比较差异均有统计学意义(P<0.05)，而术后24 h观察组患者尿海藻糖酶的含量为(2.58±0.23) μmol/L，与对照组比较差异无统计学意义(P>0.05)；观察组患者每一时间点的血清海藻糖酶均高于尿海藻糖酶，差异均有统计学意义(P<0.05)；术后12 h时尿海藻糖酶的受试者工作特征曲线(ROC曲线)下面积为0.944，敏感度为80%，特异性为100%。结论 尿海藻糖酶在失血性休克的早期开始升高，术后6到12 h达到高峰，能够较早地反映肾小管的损伤情况，具有较高的诊断敏感性和特异性，而且检测方便、无创，生理活性稳定，可作为肾功能早期损害的评测指标进一步研究。
      【关键词】 海藻糖酶；肾功能；失血性休克；ROC曲线；酶联免疫吸附法
      【中图分类号】 R541.6+4 【文献标识码】 A 【文章编号】 1003—6350（2018）19—2711—03

Value of urinary trehalase in evaluating renal dysfunction of patients with hemorrhagic shock.
YAN Lin, LIUXin-feng, LUO Jie-long, XIU Feng-min, LI De-liang. The First Department of Surgery, Tangxia Hospital of Dongguan,Dongguan 523718, Guangdong, CHINA
【Abstract】 Objective To discuss clinical value of urinary trehalase in evaluating renal dysfunction of patientswith hemorrhagic shock. Methods Patients admitted to Tangxia Hospital of Dongguan from June 2016 to November2017 who met the inclusion and exclusion criteria were selected as subjects. The 20 patients with hemorrhagic shockwere enrolled as the observation group, and the 20 healthy peoples were assigned as the control group. The optical density(OD) was detected by ELISA in the control group and in the observation group before operation, and 6 h, 12 h and 24 h af-ter operation. The standard curve was drawn, and then the content of trehalase was calculated and compared between thetwo groups. The receiver operating characteristic curve (ROC curve) was drawn and intraoperative intraperitoneal bleed-ing was recorded. Results The level of urinary trehalase in control group was (2.46±0.21) μmol/L, and the levels of uri-nary trehalase in observation group were (3.70±0.44) μmol/L before operation, (4.16±0.78) μmol/L at 6 h after operation,(3.48±0.51) μmol/L at 12 h after operation. The differences between the observation group and the control group werestatistically significant (P<0.05). The level of urinary trehalase in observation group was (2.58±0.23) μmol/L at 24 h af-ter operation, which showed no significant difference with that in the control group (P>0.05). The levels of trehalase inserum were significantly higher than those in urine at each time point in observation group (P<0.05). At 12 hours afteroperation, the area under ROC curve of urinary trehalase was 0.944, with the sensitivity of 80% and specificity of 100%.Conclusion Urinary trehalase increases at the early stage of hemorrhagic shock and reaches the peak 6 to 12 hours af-ter operation, which can reflect the damage status of renal tubules early and has high diagnostic sensitivity and specifici-ty. It can be detected conveniently and non-invasively and has stable physiological activity, and thus can be used as an in-dex to evaluate early renal dysfunction.
      【Key words】 Trehalase; Renal function; Hemorrhagic shock; Receiver operating characteristic curve; ELISA·论 著·doi:10.3969/j.issn.1003-6350.2018.19.013基金项目：广东省东莞市医疗卫生科技计划一般项目(编号：201610515000291)