摘要
目的：研究中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）及白细胞介素-18（IL-18）在冠状动脉搭桥手术（CABG）后急性肾损伤（AKI）早期诊断的价值和意义。方法选择2011年9月11日至2012年11月5日在南京市第一医院诊断为冠状动脉硬化性心脏病行CABG的患者80例，根据AKI诊断标准，所有入选的患者以发生AKI的病例定为AKI组，未发生AKI的定为非AKI组。分别留取术前及术后2、4、6、8、12、24 h时间点的血液和尿液标本，测定标本中血清肌酐，血液及尿液中KIM-1、NGAL和IL-18水平。结果80例患者共有13例发生AKI ，AKI组血清肌酐升高，峰值出现在术后12～48 h。AKI组患者术后4、6、8、12 h尿、血KIM-1，术后大部分时间点尿、血NGAL、IL-18均高于非AKI组。ROC曲线及Logistic回归分析示：术后2 h血、尿NGAL及IL-18，术后6 h血、尿KIM-1是CABG术后AKI发生的独立有效预测指标。结论 CABG术后2 h血液及尿液NGAL、IL-18，术后6 h血液及尿液 KIM-1可作为CABG术后 AKI早期诊断生物标志物；2 h时血液中NGAL、IL-18诊断价值比尿液中的NGAL、IL-18高，6 h时尿液中KIM-1的诊断价值比血液高。
Objective To evaluate the hypothesis that neutrophil gelatinase-associated lipocalin（NGAL） ,kidney injury molecule-1（KIM-1）and Interleukin-18（IL-18） are early biomarker for acute kidney injury （AKI） in patients after coronary artery bypass graft surgery（CABG） .Methods 80 patients were recruited during September 2011 to May 2012 .The patients were divided into two groups according to the AKI criteria ,patients developed postoperative AKI in AKI group ;others did not postoperative developed AKI in non-AKI group .Before and 2 ,4 ,6 ,8 ,12 ,24 h after the CABG surgery ,the urine and serum sample were collected ,serum creatinine ,the urine and serum IL-18、NGAL、KIM-1 value were test by ELISA method .Results 13 of 80 cases（16 .25% ）developed postoperative AKI according to the AKI criteria ,diagnosis with serum creatinine was only 12-48 h after cardiac surgery .Concen-trations of NGAL 、IL-18 in urine and serum at 2 h after CABG surgery ,concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI by logistic regression analysis and ROC curve .Conclusion IL-18 in urine and serum at 2 h after CABG surgery were the powerful independent predictors of AKI ,and concentrations of KIM-1 in urine and serum at 6 h were the powerful independent predictors of AKI .Serous NGAL and IL-18 is better than urinary NGAL and IL-18 in diagnosis of AKI . Urinary KIM-1 was better than serous KIM-1 in diagnosis of AKI at 6 h .
出处
《重庆医学》
CAS
CSCD
北大核心
2013年第33期3986-3988,共3页
Chongqing medicine
基金
江苏省卫生厅科技资助项目(H201036)
南京市科技资助项目(YKK10091)
