CAJ | 학술논문

目的通过对体外循环下接受心脏手术的患者,检测尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL),观察其与急性肾损伤(AKI)的关系.方法根据AKI的诊断标准,将33例在体外循环下接受心脏手术的患者分为AKI组及非AKI组,分别留取术前及术后不同时间点的血液和尿液标本,测定所有标本中的肌酐水平和尿液标本中NGAL水平.结果 ①33例患者有9例发生AKI,发生率为27%,AKI组血清肌酐(Scr)升高峰值出现在12～48 h内.②与术前相比,非AKI组患者术后2 h尿NGAL水平显著升高(P＜0.001),此后逐渐下降,其余各时间点与术前水平相比差异无统计学意义;AKI组术后2 h及术后4 h尿NGAL水平显著升高(均P＜0.001),术后8 h仍持续较高水平,但与术前水平相比差异无统计学意义.③AKI组术后各时间点的尿NGAL水平都明显高于非AKI组(均P＜0.01).④与术前相比,非AKI组患者术后2 h及4 h尿NGAL/Ucr水平显著升高(均P＜0.05),此后逐渐下降,与术前水平相比差异无统计学意义.AKI组术后2 h及术后4 h尿NGAL/Ucr水平显著升高(均P＜0.01),此后逐渐恢复到术前水平.⑤AKI组术后各时间点的尿NGAL/Ucr水平明显高于非AKI组,差异有统计学意义(均P＜0.01).⑥2 h尿NGAL和尿NGAL/Ucr的cutoff值分别在250 靏/L和250靏/mmol时,体现出较好的敏感性和特异性.⑦AKI组术后12 h Scr水平与术后2 h尿NGAL水平间存在线性相关(R=0.638,P＜0.05).结论 ①体外循环下接受心脏手术的患者AKI发生率较高,可达到27%;②术后2 h尿NGAL和术后2 h尿NGAL/Ucr可作为体外循环下心脏手术后AKI发生的早期诊断指标,其中术后2 h尿NGAL/Ucr更具敏感性;③术后2 h尿NGAL和NGAL/Ucr分别在250 靏/L和250 靏/mmol时,体现出较好的敏感性和特异性.
목적 통과대체외순배하접수심장수술적환자,검측뇨중성립세포명효매상관지질운재단백(NGAL),관찰기여급성신손상(AKI)적관계.방법 근거AKI적진단표준,장33례재체외순배하접수심장수술적환자분위AKI조급비AKI조,분별류취술전급술후불동시간점적혈액화뇨액표본,측정소유표본중적기항수평화뇨액표본중NGAL수평.결과 ①33례환자유9례발생AKI,발생솔위27%,AKI조혈청기항(Scr)승고봉치출현재12～48 h내.②여술전상비,비AKI조환자술후2 h뇨NGAL수평현저승고(P＜0.001),차후축점하강,기여각시간점여술전수평상비차이무통계학의의;AKI조술후2 h급술후4 h뇨NGAL수평현저승고(균P＜0.001),술후8 h잉지속교고수평,단여술전수평상비차이무통계학의의.③AKI조술후각시간점적뇨NGAL수평도명현고우비AKI조(균P＜0.01).④여술전상비,비AKI조환자술후2 h급4 h뇨NGAL/Ucr수평현저승고(균P＜0.05),차후축점하강,여술전수평상비차이무통계학의의.AKI조술후2 h급술후4 h뇨NGAL/Ucr수평현저승고(균P＜0.01),차후축점회복도술전수평.⑤AKI조술후각시간점적뇨NGAL/Ucr수평명현고우비AKI조,차이유통계학의의(균P＜0.01).⑥2 h뇨NGAL화뇨NGAL/Ucr적cutoff치분별재250 학/L화250학/mmol시,체현출교호적민감성화특이성.⑦AKI조술후12 h Scr수평여술후2 h뇨NGAL수평간존재선성상관(R=0.638,P＜0.05).결론 ①체외순배하접수심장수술적환자AKI발생솔교고,가체도27%;②술후2 h뇨NGAL화술후2 h뇨NGAL/Ucr가작위체외순배하심장수술후AKI발생적조기진단지표,기중술후2 h뇨NGAL/Ucr경구민감성;③술후2 h뇨NGAL화NGAL/Ucr분별재250 학/L화250 학/mmol시,체현출교호적민감성화특이성.
Objective To test the hypothesis that Neutiophil gelatinase -associated lipocalin (NGAL) is an early biomarker for acute kidney injury (AKI) in patients after cardiac surgery. Methods 33cases undergoing cardiac surgery were divided into AKI group and Non-AKI group according to the AKI cases (27%) developed postoperative AKI, but diagnosis with serum creatinine was only 12-48 hours after develope AKI were significantly higher compared with those of preoperative ( P ＜ 0. 001 ) . Urinary concentrations of NGAL at 2 h and 4 h after cardiac surgery in patients who developed AKI were significantlypatients who developed AKI were significantly higher after surgery compared with patients who did notdevelop AKI (P ＜ 0.01 ). @Urinary concentrations of NGAL/Ucr at 2 h and 4 h after cardiac surgery in patients who did not develope AKI were significantly higher compared with those of preoperative ( P ＜ 0. 05 ).Urinary concentrations of NGAL/Ucr at 2 h and 4 h after cardiac surgery in patients who developed AKI wereNGAL/Ucr in patients who developed AKI were significantly higher after surgery compared with patients who creatinine 12 h postoperative ( R = 0. 638,P ＜ 0. 05 ). Conclusions The incidence of AKI in patients after cardiac surgery is high, which accounted for 27%. The amount of NGAL and NGAL/Ucr in urine at 2 h after cardiac surgery were the powerful independent predictor of acute renal injury and urine concentrations of NGAL/Ucr is more sensitive.