摘要
目的探讨血清胱抑素C（CyC）、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素18（IL-18）、视黄醇结合蛋白（RBP）、N-乙酰-β—D-氨基葡萄糖苷酶（NAG）在成人心脏手术后急性肾损伤（AKI）早期预测和诊断中的价值及其联合应用的价值。方法前瞻性收集心脏手术患者手术前后不同时相的血尿标本，选取其中AKI患者14例，分别测定血清CyC、Scr及尿NGAL、IL-18、RBP、NAG、Cr（Ucr）水平；并选择临床资料相匹配的非AKI患者15例作为对照。观察两组患者围手术期上述5种生物学标志与Scr的动态变化。用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价标志物的单独或联合应用时诊断AKI的精确性。AKI定义为Scr水平较基础值增加≥50％。结果29例患者平均年龄（62．9±13．7）岁，基础Scr（73．2±11．9）μmol／L。除AKI组患者术中升主动脉阻断时间较非AKI组较长外[（60．63±13．92）min比（43．00±9．20）min，P=0．047]，两组其余临床指标差异均无统计学意义。AKI组患者的血尿生物学标志分别在术后早期的不同时间点显著升高。术后10h血CyC取1．31mg／L作为诊断截点时，其在AKI诊断中的敏感性（ST）和特异性（SP）分别为0．71和0．92，AUC=0．83（0．67～1．00）；术后0h尿NGAL取49．15μg／g Ucr时，ST=0．84，SP=0．80，AUC=0．85（0．70—1．00）。术后2h尿IL—18取285．65ng／gUcr时，ST=0．85，SP=0．73，AUC=0．81（0．64～0．97）。术后0h尿RBP取2934．65μg／gUcr时，ST=0．75，SP=0．67，AUC=0．77（0．60～0．95）。术后4h尿NAG取37．05U／ragUer时，ST=0．86，SP=0．67，AUC=0．72（0．53～0．92）。利用Logistie回归方程，联合以上5种标志物的最佳诊断时间点，得到AUC为0．98（0．93～1．02）（P〈0．01）。结论心脏手术后AKI患者血尿生物学标志在术后不同时间点显著升高，诊断AKI的时间早于Scr，
Objective To investigate the markers in early diagnosis of acute kidney injury （AKI） in patients undergoing heart surgery. Methods Markers included serum cystatin C （CyC）, and urinary neutrophil gelatinase-associated lipoealin （NGAL）, interleukin 18 （IL-18）, retinol binding protein （RBP） and N-acetyl-β-D-glucosaminidase （NAG）. Twenty-nine cardiac surgical patients hospitalized were enrolled in the study. Serial blood and urine samples were collected immediately before incision and at various time intervals after surgery. The primary outcome measure was AKI, defined as a 50% increase in Scr from baseline. Results The cohort consisted of 29 patients aged （62.9±13.7） years, and baseline Scr was （73.2±11.9） μmol/L. There were no significant differences in demographics between cases and controls, while the aortic clamp time was predictably longer in AKI cases as compared to controls [（60.63±13.92） vs （43.00±9.20） rain, P〈0.05]. Each biomarker differed significantly between cases and controls at least one time- point. Optimal AUCs were for CyC at 10 hours with sensitivity （ST） 0.71, specificity （SP） 0.92, AUC=0.83 （0.67-1.00）, cut-off （CO） 1.31 rag/L; NGAL at 0 hour with ST 0.84, SP 0.80, Auc= 0.85 （0.70-1.00）, CO 49.15 μg/g Ucr; IL-18 at 2 hours with ST 0.85, SP 0.73, AUC=0.81 （0.64-0.97）, CO 285.65 ng/g Ucr; RBP at 0 hour with ST 0.75, SP 0.67, AUC=0.77 （0.60- 0.95）, CO 2934.65 txg/g Ucr and NAG at 4 hours with ST 0.86, SP 0.67, AUC=0.72 （0.53- 0.92）, CO 37.05 U/rag Ucr. Using a combination of all the 5 biomarkers analyzed at the optimal time-point as above, an AUC of 0.98 （0.93-1.0：2） （P〈0.01） in this limited sample was able to obtain. Conclusions Application of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time. Of the evaluated markers, uNGAL has the best predictive profile, uRBP also shows similar predictive power. Combining all the five a
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2011年第3期164-169,共6页
Chinese Journal of Nephrology
基金
上海市医学发展基金重点研究课题（2003ZD001）
关键词
肾功能不全
急性
心脏外科手术
诊断
生物学标志
Renal insufficiency, acute
Cardiac surgery procedure
Diagnosis
Biomarker
