中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
1期
24-27
,共4页
急性肾功能不全%明胶酶类%肾损伤分子1%心脏手术
急性腎功能不全%明膠酶類%腎損傷分子1%心髒手術
급성신공능불전%명효매류%신손상분자1%심장수술
Acute kidney injury%Gelatinases%Kidney injury molecule-1%Heart surgery
目的 探讨尿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)和血清肌酐在成年人心脏手术后急性肾损伤(AKI)早期诊断中的价值.方法 收集65例行心脏外科手术患者术前及术后24、48、72 h的血、尿标本,检测血清肌酐及尿NGAL、KIM-1,其中发生AKI(AKI组)34例,未发生AKI(非AKI组)31例,并与20例健康体检者(对照组)进行比较.采用Logistic回归模型判断血清肌酐及尿NGAL、KIM-1的早期诊断价值.结果 心脏手术后AKI的发生率为52.31％(34/65).AKI组和非AKI组术前及术后24、48、72 h血清肌酐及尿NGAL、KIM-1均明显高于对照组[血清肌酐:(62.44±22.26)、(77.38±24.38)、(98.24±25.02)、(98.14±45.26)μmol/L和(56.67±21.68)、(59.25±15.58)、(55.40±22.91)、(40.10±23.45)μmol/L比(16.43±5.01)μmol/L,尿NGAL:(4.81±0.65)、(9.48±3.29)、(11.87±3.93)、(7.66±1.52) μg/L和(4.67±0.53)、(8.89±2.64)、(11.46±3.60)、(7.47±1.63) μg/L比(2.87±0.48)μg/L,尿KIM-1:(47.93±5.54)、(61.89±12.44)、(100.21±27.32)、(67.69±8.72)μg/L和(47.12±4.08)、(56.38±9.27)、(90.14±27.26)、(69.40±8.90) μg/L比(32.21±12.54) μg/L],差异有统计学意义(P＜0.01);AKI组和非AKI组术后24、48、72 h尿NGAL、KIM-1明显高于术前,差异有统计学意义(P＜0.01);AKI组术后24 h血清肌酐及尿NGAL、KIM-1均明显高于非AKI组,差异有统计学意义(P＜0.01).术后24h尿NGAL、KIM-1诊断AKI的敏感度和特异度与血清肌酐比较差异无统计学意义(P＞0.05).结论 接受体外循环心脏手术的成年人术后AKI发生率高;术后24h对于传统诊断金标准的血清肌酐与早期生物学标记物尿NGAL、KIM-1在诊断AKI上具有相似的敏感度和特异度.
目的 探討尿中性粒細胞明膠酶相關脂質運載蛋白(NGAL)、腎損傷分子-1(KIM-1)和血清肌酐在成年人心髒手術後急性腎損傷(AKI)早期診斷中的價值.方法 收集65例行心髒外科手術患者術前及術後24、48、72 h的血、尿標本,檢測血清肌酐及尿NGAL、KIM-1,其中髮生AKI(AKI組)34例,未髮生AKI(非AKI組)31例,併與20例健康體檢者(對照組)進行比較.採用Logistic迴歸模型判斷血清肌酐及尿NGAL、KIM-1的早期診斷價值.結果 心髒手術後AKI的髮生率為52.31％(34/65).AKI組和非AKI組術前及術後24、48、72 h血清肌酐及尿NGAL、KIM-1均明顯高于對照組[血清肌酐:(62.44±22.26)、(77.38±24.38)、(98.24±25.02)、(98.14±45.26)μmol/L和(56.67±21.68)、(59.25±15.58)、(55.40±22.91)、(40.10±23.45)μmol/L比(16.43±5.01)μmol/L,尿NGAL:(4.81±0.65)、(9.48±3.29)、(11.87±3.93)、(7.66±1.52) μg/L和(4.67±0.53)、(8.89±2.64)、(11.46±3.60)、(7.47±1.63) μg/L比(2.87±0.48)μg/L,尿KIM-1:(47.93±5.54)、(61.89±12.44)、(100.21±27.32)、(67.69±8.72)μg/L和(47.12±4.08)、(56.38±9.27)、(90.14±27.26)、(69.40±8.90) μg/L比(32.21±12.54) μg/L],差異有統計學意義(P＜0.01);AKI組和非AKI組術後24、48、72 h尿NGAL、KIM-1明顯高于術前,差異有統計學意義(P＜0.01);AKI組術後24 h血清肌酐及尿NGAL、KIM-1均明顯高于非AKI組,差異有統計學意義(P＜0.01).術後24h尿NGAL、KIM-1診斷AKI的敏感度和特異度與血清肌酐比較差異無統計學意義(P＞0.05).結論 接受體外循環心髒手術的成年人術後AKI髮生率高;術後24h對于傳統診斷金標準的血清肌酐與早期生物學標記物尿NGAL、KIM-1在診斷AKI上具有相似的敏感度和特異度.
목적 탐토뇨중성립세포명효매상관지질운재단백(NGAL)、신손상분자-1(KIM-1)화혈청기항재성년인심장수술후급성신손상(AKI)조기진단중적개치.방법 수집65례행심장외과수술환자술전급술후24、48、72 h적혈、뇨표본,검측혈청기항급뇨NGAL、KIM-1,기중발생AKI(AKI조)34례,미발생AKI(비AKI조)31례,병여20례건강체검자(대조조)진행비교.채용Logistic회귀모형판단혈청기항급뇨NGAL、KIM-1적조기진단개치.결과 심장수술후AKI적발생솔위52.31％(34/65).AKI조화비AKI조술전급술후24、48、72 h혈청기항급뇨NGAL、KIM-1균명현고우대조조[혈청기항:(62.44±22.26)、(77.38±24.38)、(98.24±25.02)、(98.14±45.26)μmol/L화(56.67±21.68)、(59.25±15.58)、(55.40±22.91)、(40.10±23.45)μmol/L비(16.43±5.01)μmol/L,뇨NGAL:(4.81±0.65)、(9.48±3.29)、(11.87±3.93)、(7.66±1.52) μg/L화(4.67±0.53)、(8.89±2.64)、(11.46±3.60)、(7.47±1.63) μg/L비(2.87±0.48)μg/L,뇨KIM-1:(47.93±5.54)、(61.89±12.44)、(100.21±27.32)、(67.69±8.72)μg/L화(47.12±4.08)、(56.38±9.27)、(90.14±27.26)、(69.40±8.90) μg/L비(32.21±12.54) μg/L],차이유통계학의의(P＜0.01);AKI조화비AKI조술후24、48、72 h뇨NGAL、KIM-1명현고우술전,차이유통계학의의(P＜0.01);AKI조술후24 h혈청기항급뇨NGAL、KIM-1균명현고우비AKI조,차이유통계학의의(P＜0.01).술후24h뇨NGAL、KIM-1진단AKI적민감도화특이도여혈청기항비교차이무통계학의의(P＞0.05).결론 접수체외순배심장수술적성년인술후AKI발생솔고;술후24h대우전통진단금표준적혈청기항여조기생물학표기물뇨NGAL、KIM-1재진단AKI상구유상사적민감도화특이도.
Objective To explore the value of neutrophils gelatinases related lipid a carrier protein (NGAL),renal injury molecule-1 (KIM-1) and serum creatinine (SCr) for early diagnosis in adult cardiac surgery after acute renal injury (AKI).Methods Blood and urine samples of 65 cardiac surgery patients before and 24,48,72 h after surgery were collected,SCr,urine NGAL and KIM-1 levels was detected,among whom AKI occurred in 34 cases(AKI group),did not occur in 31 cases (non AKI group),and they were compared with 20 cases of healthy physical examination (control group).Logistic regression model was used to judge the value of early diagnosis of SCr,urine NGAL and KIM-1.Results The incidence of AKI after cardiac surgery was 52.31％ (34/65).The SCr,urine NGAL and KIM-1 levels in AKI group and non AKI group before and 24,48,72 h after surgery were significantly higher than those in control group [SCr:(62.44 ±22.26),(77.38 ±24.38),(98.24 ±25.02),(98.14 ±45.26)μmol/L and (56.67 ±21.68),(59.25 ± 15.58),(55.40 ±22.91),(40.10 ±23.45)μmol/L vs.(16.43 ±5.01)μmol/L;urine NGAL:(4.81 ±0.65),(9.48 ±3.29),(11.87 ±3.93),(7.66 ± 1.52) μg/L and (4.67 ±0.53),(8.89 ± 2.64),(11.46 ± 3.60),(7.47 ± 1.63)μg/L vs.(2.87 ± 0.48) μg/L; KIM-1:(47.93 ± 5.54),(61.89 ± 12.44),(100.21 ± 27.32),(67.69 ± 8.72) μ g/L and (47.12 ± 4.08),(56.38 ± 9.27),(90.14 ± 27.26),(69.40 ±8.90) μ g/L vs.(32.21 ± 12.54)μ g/L] (P ＜ 0.01).Urine NGAL and KIM-1 levels in AKI group and non AKI group 24,48,72 h after surgery were significantly higher than those before surgery (P＜ 0.01).SCr,urine NGAL and KIM-1 levels in AKI group 24 h after surgery were significantly higher than those in non AKI group (P＜ 0.01).Twenty-four hours after surgery,the sensitivity and specificity of urine NGAL,KIM-1 in the diagnosis of AKI,compared with that of SCr had no statistical significance (P ＞ 0.05).Conclusions The adults who accept extracorporeal circulation cardiac surgery appear high incidence of AKI.Twenty-four hours after surgery,early biological markers-urine AKI,KIM-1,has similar sensitivity and specificity with traditional diagnostic gold standard of SCr.
