2026 年第 7 期 第 21 卷

血清肾损伤分子1在急性心肌梗死患者急性肾损伤早期预测中的价值研究

Value of serum kidney injury molecule-1 in early prediction of acute kidney injury in patients with acute myocardial infarction

作者：朱佳佳1张宁1陈立颖1刘宝利2

英文作者：Zhu Jiajia1 Zhang Ning1 Chen Liying1 Liu Baoli2

单位：1首都医科大学附属北京安贞医院心脏内科危重症中心，北京100029；2首都医科大学附属北京中医医院肾内科，北京100010

英文单位：1Critical Care Center of Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Nephrology Beijing Hospital of Traditional Chinese Medicine Capital Medical University Beijing 100010 China

关键词：急性心肌梗死；急性肾损伤；肾损伤分子1；心肾综合征；早期检测；危险分层

英文关键词：Acutemyocardialinfarction;Acutekidneyinjury;Kidneyinjurymolecule-1;Cardiorenalsyndrome;Earlydetection;Riskstratification

• 摘要：

• 目的 探讨血清肾损伤分子 1（KIM-1）对急性心肌梗死（AMI）患者发病后72 h内急性肾损伤（AKI）早期危险分层的潜在价值。方法 连续纳入2025年11月至2026年1月于首都医科大学附属北京安贞医院住院的30例AMI患者开展单中心前瞻性初步研究。依据是否发生AKI分为AKI组（10例）和非AKI组（20例）。于入院即刻（T0）、入院后 6～12 h（T1）、入院后24 h（T2）、入院后48 h（T3）、入院后72 h（T4）采集血清，检测KIM-1与血肌酐水平，采用受试者工作特征曲线分析其预测72 h内AKI的价值。本研究为探索性研究，样本量有限，结果仅用于提出假设并报告置信区间。结果 AKI组T0时点KIM-1水平显著高于非AKI组［0.150(0.095，0.305)μg/L比0.080(0.058，0.132)μg/L］（P=0.019）；T0时点KIM-1 预测72 h内AKI的曲线下面积（AUC）为0.77（95%置信区间：0.52～0.94），优于同期血肌酐（AUC=0.66，95%置信区间：0.45～0.88）。以0.100 μg/L为临界值，KIM-1预测AKI的敏感度为100%（95%置信区间：69%～100%）、特异度为60%（95%置信区间：36%～81%）。在2组从症状发作到入院的中位时间一致情况下，患者KIM-1于T0时点即表现组间差异，血肌酐直至T2时点才出现差异，二者时间差约24 h。结论 入院时血清KIM-1对AMI后AKI发生具有早期危险分层的潜在价值，检出时间早于血肌酐，但其探索性结果需大样本、多中心研究外部验证及临床实用性评估后，方可转化应用。

• Objective To explore the potential value of serum kidney injury molecule-1 (KIM-1) in the early risk stratification of acute kidney injury (AKI) within 72 h after onset in patients with acute myocardial infarction (AMI). Methods A total of 30 consecutive AMI patients hospitalized in Beijing Anzhen Hospital, Capital Medical University from November 2025 to January 2026 were enrolled in this single-center prospective preliminary study. Patients were divided into AKI group (10 cases) and non-AKI group (20 cases) according to the occurrence of AKI. Serum samples were collected at admission immediately (T0), 6-12 h after admission (T1), 24 h after admission (T2), 48 h after admission (T3), and 72 h after admission (T4) to detect the levels of KIM-1 and serum creatinine. Receiver operating characteristic curve was used to analyze its value in predicting AKI within 72 h. As an exploratory study with a limited sample size, the results were only used to generate hypotheses and report confidence intervals. Results The level of KIM-1 at T0 in the AKI group was significantly higher than that in the non-AKI group ［0.150(0.095, 0.305)μg/L vs 0.080(0.058, 0.132)μg/L］(P=0.019). The area under the curve (AUC) of KIM-1 at T0 for predicting AKI within 72 h was 0.77 (95% confidence interval: 0.52-0.94), which was superior to serum creatinine at the same time point (AUC=0.66, 95% confidence interval: 0.45-0.88). Taking 0.100 μg/L as the cut-off value, the sensitivity of KIM-1 for predicting AKI was 100% (95% confidence interval: 69%-100%) and the specificity was 60% (95% confidence interval: 36%-81%). With the consistent median time from symptom onset to admission between the two groups, KIM-1 showed intergroup differences at T0, while serum creatinine did not show significant differences until T2, with a time difference of approximately 24 h. Conclusion sSerum KIM-1 at admission has potential value for early risk stratification of AKI after AMI, with an earlier detection time than serum creatinine. However, these exploratory findings need external verification by large-sample and multicenter studies as well as clinical practicability evaluation before clinical transformation and application.