目的　探讨尿胰岛素样生长因子结合蛋白7（IGFBP-7）对危重症患儿急性肾损伤（AKI）的早期预测价值。方 法　选择2012年5月至8月儿童重症监护病房（PICU）收治的患儿为研究对象。分为轻度AKI（AKI 1期）、严重AKI（AKI 2和3期）和非AKI组。检测入PICU第一个24小时尿 IGFBP-7水平，并于入 PICU 24小时内行儿童死亡风险Ⅲ（PRISM Ⅲ） 评分。以多因素logistic回归分析评估在校正混杂因素后尿 IGFBP-7 与 AKI 的关系，用受试者工作特征曲线（ROC）及曲 线下面积（AUC）评价尿 IGFBP-7 对危重症患儿 AKI 的早期预测价值。结果　共纳入危重症患儿144例，21例（14.6%） 在样本采集120小时内发生 AKI，其中严重 AKI 11例。严重AKI组入PICU第一个24小时的尿 IGFBP-7 水平、PRISM Ⅲ 评分均高于轻度 AKI 及无AKI 组，差异均有统计学意义（P<0.05）。Logistic回归分析显示，在校正年龄、体质量、PRISM Ⅲ评分后，尿 IGFBP-7 是严重 AKI的独立危险因素（OR=2.93，95%CI：1.07~8.03， P=0.037），预测危重症患儿严重 AKI 的AUC值为0.79（95%CI：0.66~0.92， P=0.001）。 结论　尿 IGFBP-7 是危重症患儿严重AKI的独立预测指标，具 有早期预测价值。

Objective　To explore the early predictive value of urinary insulin-like growth factor binding protein 7 (IGFBP-7) in acute kidney injury (AKI) in critically ill children. Method　The children admitted to PICU from May to August 2012 were selected as the research subjects. They were divided into mild AKI (AKI phase 1), severe AKI (AKI phase 2 and 3) and non-AKI groups. The IGFBP-7 levels in first 24-hour urinary were detected and the pediatric risk of mortality Ⅲ (PRISM Ⅲ) score was calculated 24 hours after admission. Multivariate logistic regression analysis was used to evaluate the relationship between urinary IGFBP-7 and AKI after correction of confounding factors. The early predictive value of urinary IGFBP-7 for AKI in critically ill children was evaluated by ROC and AUC. Results　A total of 144 children with critical illness were enrolled. AKI occurred in 21 children (14.6%) within 120 hours after sample collection, including 11 children with severe AKI. The urinary IGFBP-7 level and PRISM III score in the first 24 hours after PICU admission were higher in severe AKI group than those in mild AKI group and non-AKI group, and differences were significant (both P<0.05). Logistic regression analysis showed that urinary IGFBP-7 was an independent risk factor for severe AKI (OR=2.93, 95%CI: 1.07~8.03, P=0.037) after adjusting for age, body mass and PRISM III score, and its predicting value was 0.79 by AUC (95%CI: 0.66~0.92, P=0.001). Conclusion Urinary IGFBP-7 is an independent predictor of severe AKI in critically ill children and has early predictive value.