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目的:探讨肾损伤标志性蛋白在烧伤延迟复苏患者急性肾损伤(AKI)早期诊断中的价值。方法:采用回顾性病例对照研究方法。2018年5月—2020年5月，郑州市第一人民医院收治43例符合入选标准的烧伤延迟复苏患者，其中男27例、女16例，年龄18～75(35±3)岁，按伤后7 d内是否发生AKI分为AKI组23例及非AKI组20例。比较2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、急性生理学和慢性健康状况评价Ⅱ，统计伤后12、24、48 h补液量和血清肌酐及伤后12、24、48、72、120、168 h血清白蛋白/纤维蛋白原比值(AFR)，尿热休克蛋白70(HSP70)、金属蛋白酶组织抑制因子2(TIMP-2)×胰岛素样生长因子结合蛋白7(IGFBP-7)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。对数据行Mann-Whitney n U检验、重复测量方差分析、独立样本n t检验、n χ2检验及Bonferroni校正，行多因素logistic回归分析筛选预测AKI发生的自变量，绘制预测烧伤延迟复苏患者AKI发生的受试者操作特征曲线，计算诊断AKI的曲线下面积(AUC)、最佳阈值及最佳阈值下的敏感度、特异度。n 结果:2组患者性别、年龄、深Ⅱ度烧伤面积、Ⅲ度烧伤面积、急性生理学和慢性健康状况评价Ⅱ相近(n χ2＝1.98，n t＝1.98、1.99、1.99、1.99，n P>0.05)。AKI组患者伤后24、48 h补液量明显少于非AKI组(n t＝15.37、6.51，n P<0.01)。AKI组患者伤后12、24、48 h血清肌酐明显高于非AKI组(n Z＝2.16、5.62、6.72，n P<0.01)。AKI组患者伤后12、24、48、72、120、168 h血清AFR明显低于非AKI组(n t＝16.14、35.35、19.60、20.47、30.20、20.17，n P<0.01)。AKI组患者伤后12、24、48、72、120、168 h尿HSP70为(6.89±0.87)、(6.42±0.73)、(5.81±0.72)、(5.17±0.56)、(4.63±0.51)、(3.89±0.51)μg/L，明显高于非AKI组的(3.89±0.75)、(3.57±0.63)、(2.66±0.41)、(1.83±0.35)、(1.48±0.19)、(1.28±0.19)μg/L，n t＝12.00、13.61、17.39、22.98、26.34、21.59，n P<0.01。AKI组患者伤后12、24、48、72、120、168 h尿TIMP-2×IGFBP-7、NGAL明显高于非AKI组(n t＝26.94、101.11、35.50、66.89、17.34、14.30，14.00、13.78、12.32、14.80、21.36、22.62，n P<0.01)。将伤后12 h尿HSP70和血清AFR，伤后24 h尿TIMP-2×IGFBP-7、NGAL纳入多因素logistic回归分析(比值比＝2.42、3.47、7.52、5.61，95%置信区间＝1.99～2.95、1.86～3.92、2.87～9.68、2.14～14.69，n P0.05). The fluid supplement volume of patients in AKI group at 24 and 48 h after burn was significantly less than that in non-AKI group (n t=15.37, 6.51, n P<0.01). The serum creatinine of patients in AKI group at 12, 24, and 48 h after burn was significantly higher than that in non-AKI group (n Z=2.16, 5.62, 6.72, n P<0.01). The serum AFR of patients in AKI group at 12, 24, 48, 72, 120, and 168 h after burn was significantly lower than that in non-AKI group (n t=16.14, 35.35, 19.60, 20.47, 30.20, 20.17, n P<0.01). The levels of urinary HSP70 of patients in AKI group at 12, 24, 48, 72, 120, and 168 h after burn were (6.89±0.87), (6.42±0.73), (5.81±0.72), (5.17±0.56), (4.63±0.51), (3.89±0.51) μg/L, which were significantly higher than (3.89±0.75), (3.57±0.63), (2.66±0.41), (1.83±0.35), (1.48±0.19), (1.28±0.19) μg/L in non-AKI group (n t=12.00, 13.61, 17.39, 22.98, 26.34, 21.59, n P<0.01). Urinary TIMP-2×IGFBP-7 and NGAL of patients in AKI group at 12, 24, 48, 72, 120, 168 h after burn were significantly higher than those in non-AKI group (n t=26.94, 101.11, 35.50, 66.89, 17.34, 14.30, 14.00, 13.78, 12.32, 14.80, 21.36, 22.62, n P<0.01). Urinary HSP70 and serum AFR at 12 h after burn, urinary TIMP-2×IGFBP-7 and NGAL at 24 h after burn were included into multi-factor logistic regression analysis (odds ratio=2.42, 3.47, 7.52, 5.61, 95% confidence interval=1.99-2.95, 1.86-3.92, 2.87-9.68, 2.14-14.69,n P<0.01). For 43 patients with burn delayed resuscitation, the AUC of receiver′s operating characteristic curve of serum AFR at 12 h after burn for predicting AKI was 0.739 (95% confidence interval=0.576-0.903), the optimal threshold was 9.90, the sensitivity was 82%, and the specificity was 90%. The AUC of urinary HSP70 at 12 h after burn was 0.990 (95% confidence interval=0.920-1.000), the optimal threshold was 1.40 μg/L, the sensitivity was 98%, and the specificity was 96%. The AUC of urinary TIMP-2×IGFBP-7 at 24 h after burn was 0.715 (95% confidence interval=0.512-0.890), the optimal threshold was 114.20 μgn 2/Ln 2, the sensitivity was 91%, and the specificity was 95%. The AUC of urinary NGAL at 24 h after burn was 0.972 (95% confidence interval=0.860-1.000), the optimal threshold was 78 μg/L, the sensitivity was 95%, and the specificity was 96%.n Conclusions:Urinary HSP70 and NGAL have higher value in early diagnosis of AKI in burn patients with delayed resuscitation.