中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
5期
361-366
,共6页
刘上%车妙琳%谢波%薛松%朱铭力%陆任华%张伟明%钱家麒%倪兆慧%严玉澄
劉上%車妙琳%謝波%薛鬆%硃銘力%陸任華%張偉明%錢傢麒%倪兆慧%嚴玉澄
류상%차묘림%사파%설송%주명력%륙임화%장위명%전가기%예조혜%엄옥징
肾功能不全,急性%脂肪酸结合蛋白类%明胶酶类%脂笼蛋白质类%心脏手术
腎功能不全,急性%脂肪痠結閤蛋白類%明膠酶類%脂籠蛋白質類%心髒手術
신공능불전,급성%지방산결합단백류%명효매류%지롱단백질류%심장수술
Renal insufficiency,acute%Fatty acid-binding proteins%Gelatinases%Lipocalins%Cardiac surgery
目的 探讨尿肝型脂肪酸结合蛋白( L-FABP)及其与尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合应用在预测成人心脏手术后急性肾损伤(AKI)的发生及严重程度中的价值,以期能为临床AKI的早期诊断提供方便可靠的方法.方法 前瞻性收集心脏手术患者术前、术后即刻及术后2h的血和尿标本,分别检测Scr、尿L-FABP和NGAL水平,比较AKI和非AKI患者术后各标志物的动态变化情况.运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估标志物单独及联合应用时诊断AKI的准确性.结果 总共109例患者中26例(23.9％)发生了AKI,其中AKIN Ⅰ、Ⅱ和Ⅲ期分别占46.2％ 、34.6％和19.2％.尿L-FABP 和NGAL水平在AKI组术后即刻及术后2h均显著高于非AKI组,其浓度变化明显早于Scr.两时间点各标志物单独预测AKI的发生及Ⅱ和Ⅲ期AKI的AUC均在0.81～0.87.用Logistic 回归方程联合术后同一时间点的尿NGAL和尿L-FABP,则术后即刻和术后2h预测术后AKI 及严重程度的精确性进一步提高( AUC=0.911～0.927).结论 尿L-FABP和尿NGAL在心脏术后AKI早期即显著升高,比Scr能更早地预测AKI的发生和严重程度,两者联合应用则可使诊断的精确性进一步提高.
目的 探討尿肝型脂肪痠結閤蛋白( L-FABP)及其與尿中性粒細胞明膠酶相關脂質運載蛋白(NGAL)聯閤應用在預測成人心髒手術後急性腎損傷(AKI)的髮生及嚴重程度中的價值,以期能為臨床AKI的早期診斷提供方便可靠的方法.方法 前瞻性收集心髒手術患者術前、術後即刻及術後2h的血和尿標本,分彆檢測Scr、尿L-FABP和NGAL水平,比較AKI和非AKI患者術後各標誌物的動態變化情況.運用受試者工作特徵(ROC)麯線及麯線下麵積(AUC)評估標誌物單獨及聯閤應用時診斷AKI的準確性.結果 總共109例患者中26例(23.9％)髮生瞭AKI,其中AKIN Ⅰ、Ⅱ和Ⅲ期分彆佔46.2％ 、34.6％和19.2％.尿L-FABP 和NGAL水平在AKI組術後即刻及術後2h均顯著高于非AKI組,其濃度變化明顯早于Scr.兩時間點各標誌物單獨預測AKI的髮生及Ⅱ和Ⅲ期AKI的AUC均在0.81～0.87.用Logistic 迴歸方程聯閤術後同一時間點的尿NGAL和尿L-FABP,則術後即刻和術後2h預測術後AKI 及嚴重程度的精確性進一步提高( AUC=0.911～0.927).結論 尿L-FABP和尿NGAL在心髒術後AKI早期即顯著升高,比Scr能更早地預測AKI的髮生和嚴重程度,兩者聯閤應用則可使診斷的精確性進一步提高.
목적 탐토뇨간형지방산결합단백( L-FABP)급기여뇨중성립세포명효매상관지질운재단백(NGAL)연합응용재예측성인심장수술후급성신손상(AKI)적발생급엄중정도중적개치,이기능위림상AKI적조기진단제공방편가고적방법.방법 전첨성수집심장수술환자술전、술후즉각급술후2h적혈화뇨표본,분별검측Scr、뇨L-FABP화NGAL수평,비교AKI화비AKI환자술후각표지물적동태변화정황.운용수시자공작특정(ROC)곡선급곡선하면적(AUC)평고표지물단독급연합응용시진단AKI적준학성.결과 총공109례환자중26례(23.9％)발생료AKI,기중AKIN Ⅰ、Ⅱ화Ⅲ기분별점46.2％ 、34.6％화19.2％.뇨L-FABP 화NGAL수평재AKI조술후즉각급술후2h균현저고우비AKI조,기농도변화명현조우Scr.량시간점각표지물단독예측AKI적발생급Ⅱ화Ⅲ기AKI적AUC균재0.81～0.87.용Logistic 회귀방정연합술후동일시간점적뇨NGAL화뇨L-FABP,칙술후즉각화술후2h예측술후AKI 급엄중정도적정학성진일보제고( AUC=0.911～0.927).결론 뇨L-FABP화뇨NGAL재심장술후AKI조기즉현저승고,비Scr능경조지예측AKI적발생화엄중정도,량자연합응용칙가사진단적정학성진일보제고.
Objective To investigate the value of urinary liver-type fatty acid-binding protein (L-FABP),neutrophil gelatinase-associated lipocalin (NGAL) and their combination in predicting the development and the severity of acute kidney injury (AKI) following cardiac surgery in adults. Methods Scr,urinary L-FABP and NGAL corrected by urine creatinine at preoperation,0 h and 2 h postoperative time points were examined.The differences of above indexes between AKI and non-AKI groups were compared.Receiver operating characteristic (ROC)curves and area under curves (AUC) were used to evaluate the diagnostic value of urinary L-FABP,NGAL and their combination for AKI. Results The cohort consisted of 109 patients,26(23.9％) developed AKI,and AKIN stage Ⅰ, Ⅱ and Ⅲ was 46.2％,34.6％ and 19.2％ respectively.Levels of urinary L-FABP and NGAL were significantly higher in AKI patients at 0 h and 2 h postoperatively.AUC to predict AKI or AKI stage Ⅱ-Ⅲ was 0.81 to 0.87 using either of the biomarkers.The performance of combining two biomarkers was better with AUC of 0.911 to 0.927. Conclusions Urinary L-FABP and NGAL increase at the early stage after cardiac surgery.Combination of these two biomarkers enhances the accuracy of the early diagnosis of postoperative AKI after cardiac surgery before a rise of Scr.
