中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2011年
3期
164-169
,共6页
车妙琳%钱家麒%戴慧莉%吴青伟%倪兆慧%薛松%严玉澄
車妙琳%錢傢麒%戴慧莉%吳青偉%倪兆慧%薛鬆%嚴玉澄
차묘림%전가기%대혜리%오청위%예조혜%설송%엄옥징
肾功能不全,急性%心脏外科手术%诊断%生物学标志
腎功能不全,急性%心髒外科手術%診斷%生物學標誌
신공능불전,급성%심장외과수술%진단%생물학표지
Renal insufficiency,acute%Cardiac surgery procedure%Diagnosis%Biomarker
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种牛物学标志与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问较非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10 h血CyC取1.31 mg/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0 h尿NGAL取49.15 μg/g Ucr时,ST=0.84,SP=0.80,AUC=0.85(0.70-1.00).术后2 h尿IL-18取285.65 ng/g Ucr时,ST=0.85,SP=0.73,AUC=0.81(0.64-0.97).术后0 h尿RBP取2934.65 μg/g Ucr时,ST=0.75,SP=0.67,AUC=0.77(0.60～0.95).术后4 h尿NAG取37.05 U/mg Ucr时,ST=0.86,SP=0.67,AUC=0.72(0.53～0.92).利用Logistic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,具有较高的准确性,可作为成人心脏手术后AKI的早期诊断标志物.尿NGAL的ROC曲线下面积最大,尿RBP也显示了较好的诊断价值.联合应用生物学标志可更好地预测临床上AKI的发生.
目的 探討血清胱抑素C(CyC)、尿中性粒細胞明膠酶相關脂質運載蛋白(NGAL)、白細胞介素18(IL-18)、視黃醇結閤蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)在成人心髒手術後急性腎損傷(AKI)早期預測和診斷中的價值及其聯閤應用的價值.方法 前瞻性收集心髒手術患者手術前後不同時相的血尿標本,選取其中AKI患者14例,分彆測定血清CyC、Scr及尿NGAL、IL-18、RBP、NAG、Cr(Ucr)水平;併選擇臨床資料相匹配的非AKI患者15例作為對照.觀察兩組患者圍手術期上述5種牛物學標誌與Scr的動態變化.用受試者工作特徵(ROC)麯線及麯線下麵積(AUC)評價標誌物的單獨或聯閤應用時診斷AKI的精確性.AKI定義為Scr水平較基礎值增加≥50%.結果 29例患者平均年齡(62.9±13.7)歲,基礎Scr(73.2±11.9)μmol/L.除AKI組患者術中升主動脈阻斷時問較非AKI組較長外[(60.63±13.92)min比(43.00±9.20)min,P=0.047],兩組其餘臨床指標差異均無統計學意義.AKI組患者的血尿生物學標誌分彆在術後早期的不同時間點顯著升高.術後10 h血CyC取1.31 mg/L作為診斷截點時,其在AKI診斷中的敏感性(ST)和特異性(SP)分彆為0.71和0.92,AUC=0.83(0.67-1.00);術後0 h尿NGAL取49.15 μg/g Ucr時,ST=0.84,SP=0.80,AUC=0.85(0.70-1.00).術後2 h尿IL-18取285.65 ng/g Ucr時,ST=0.85,SP=0.73,AUC=0.81(0.64-0.97).術後0 h尿RBP取2934.65 μg/g Ucr時,ST=0.75,SP=0.67,AUC=0.77(0.60～0.95).術後4 h尿NAG取37.05 U/mg Ucr時,ST=0.86,SP=0.67,AUC=0.72(0.53～0.92).利用Logistic迴歸方程,聯閤以上5種標誌物的最佳診斷時間點,得到AUC為0.98(0.93-1.02)(P<0.01).結論 心髒手術後AKI患者血尿生物學標誌在術後不同時間點顯著升高,診斷AKI的時間早于Scr,具有較高的準確性,可作為成人心髒手術後AKI的早期診斷標誌物.尿NGAL的ROC麯線下麵積最大,尿RBP也顯示瞭較好的診斷價值.聯閤應用生物學標誌可更好地預測臨床上AKI的髮生.
목적 탐토혈청광억소C(CyC)、뇨중성립세포명효매상관지질운재단백(NGAL)、백세포개소18(IL-18)、시황순결합단백(RBP)、N-을선-β-D-안기포도당감매(NAG)재성인심장수술후급성신손상(AKI)조기예측화진단중적개치급기연합응용적개치.방법 전첨성수집심장수술환자수술전후불동시상적혈뇨표본,선취기중AKI환자14례,분별측정혈청CyC、Scr급뇨NGAL、IL-18、RBP、NAG、Cr(Ucr)수평;병선택림상자료상필배적비AKI환자15례작위대조.관찰량조환자위수술기상술5충우물학표지여Scr적동태변화.용수시자공작특정(ROC)곡선급곡선하면적(AUC)평개표지물적단독혹연합응용시진단AKI적정학성.AKI정의위Scr수평교기출치증가≥50%.결과 29례환자평균년령(62.9±13.7)세,기출Scr(73.2±11.9)μmol/L.제AKI조환자술중승주동맥조단시문교비AKI조교장외[(60.63±13.92)min비(43.00±9.20)min,P=0.047],량조기여림상지표차이균무통계학의의.AKI조환자적혈뇨생물학표지분별재술후조기적불동시간점현저승고.술후10 h혈CyC취1.31 mg/L작위진단절점시,기재AKI진단중적민감성(ST)화특이성(SP)분별위0.71화0.92,AUC=0.83(0.67-1.00);술후0 h뇨NGAL취49.15 μg/g Ucr시,ST=0.84,SP=0.80,AUC=0.85(0.70-1.00).술후2 h뇨IL-18취285.65 ng/g Ucr시,ST=0.85,SP=0.73,AUC=0.81(0.64-0.97).술후0 h뇨RBP취2934.65 μg/g Ucr시,ST=0.75,SP=0.67,AUC=0.77(0.60～0.95).술후4 h뇨NAG취37.05 U/mg Ucr시,ST=0.86,SP=0.67,AUC=0.72(0.53～0.92).이용Logistic회귀방정,연합이상5충표지물적최가진단시간점,득도AUC위0.98(0.93-1.02)(P<0.01).결론 심장수술후AKI환자혈뇨생물학표지재술후불동시간점현저승고,진단AKI적시간조우Scr,구유교고적준학성,가작위성인심장수술후AKI적조기진단표지물.뇨NGAL적ROC곡선하면적최대,뇨RBP야현시료교호적진단개치.연합응용생물학표지가경호지예측림상상AKI적발생.
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 lipocalin(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 difiered significantly between cases and controls at least one timepoint.Optimal AUCs were for CyC at 10 houm with sensitivity (ST)0.71,specificity(SP)0.92,AUC=0.83(0.67-1.00),cut-off(CO)1.31 mg/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 2934.65μg/g Ucr and NAG at 4 hours with ST 0.86,SP 0.67,AUC=0.72(0.53-O.92),CO 37.05 U/mg Ucr.Using a combination of all the 5 biomarkers analyzed at the optimal time-point as above,an AUC of 0.98(0.93-1.02)(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 above biomarkers is able to predict significantly more cases,suggesting that the use of more than one marker may be beneficial clinically.
