CAJ | 학술논문

目的：评价尿液中胱抑素 C（Cys C）及肾损伤分子-1（KIM -1）联合检测在冠状动脉旁路移植术后急性肾损伤（AKI）中的临床意义。方法回顾性分析2011年5月至2013年10月在非体外循环下行冠状动脉旁路移植术的182例患者临床资料。其中23例患者发生急性肾损伤（AKI 组），159例患者未发生急性肾损伤（非 AKI 组）。分别检测两组术前，麻醉诱导后，术后12 h、24 h、48 h、72 h 的血清肌酐（Scr）、血清尿素氮（BUN）水平的变化以及尿液中胱抑素 C （Cys C）及肾损伤分子-1（KIM -1）的含量，分析各项指标含量的变化与急性肾损伤的关系。结果在冠状动脉旁路移植术前两组各项指标均无统计学差异（ P ﹥0.05）。冠状动脉旁路移植术后，AKI 组 Scr、BUN 含量在术后72 h 时均较术前各时间段增高，且与非 AKI 组间比较有统计学差异（ P ﹤0.05）；AKI 组患者尿液 Cys C 含量于术后12 h 增高，24 h 达高峰值，48 h 后逐渐下降，与非 AKI 组比较有统计学差异（ P ﹤0.05）；AKI 组尿液中 KIM -1含量于术后24 h 增高，48 h达高峰值，明显高于同期非 AKI 组，组间比较有统计学差异（ P ﹤0.05）。结论冠状动脉旁路移植术后早期联合检测尿液 Cys C、KIM -1含量的变化，对诊断急性肾损伤有指导意义。
목적：평개뇨액중광억소 C（Cys C）급신손상분자-1（KIM -1）연합검측재관상동맥방로이식술후급성신손상（AKI）중적림상의의。방법회고성분석2011년5월지2013년10월재비체외순배하행관상동맥방로이식술적182례환자림상자료。기중23례환자발생급성신손상（AKI 조），159례환자미발생급성신손상（비 AKI 조）。분별검측량조술전，마취유도후，술후12 h、24 h、48 h、72 h 적혈청기항（Scr）、혈청뇨소담（BUN）수평적변화이급뇨액중광억소 C （Cys C）급신손상분자-1（KIM -1）적함량，분석각항지표함량적변화여급성신손상적관계。결과재관상동맥방로이식술전량조각항지표균무통계학차이（ P ﹥0.05）。관상동맥방로이식술후，AKI 조 Scr、BUN 함량재술후72 h 시균교술전각시간단증고，차여비 AKI 조간비교유통계학차이（ P ﹤0.05）；AKI 조환자뇨액 Cys C 함량우술후12 h 증고，24 h 체고봉치，48 h 후축점하강，여비 AKI 조비교유통계학차이（ P ﹤0.05）；AKI 조뇨액중 KIM -1함량우술후24 h 증고，48 h체고봉치，명현고우동기비 AKI 조，조간비교유통계학차이（ P ﹤0.05）。결론관상동맥방로이식술후조기연합검측뇨액 Cys C、KIM -1함량적변화，대진단급성신손상유지도의의。
Objective To analyze the clinical significance of cystatin C(Cys C)and kidney injury molecule - 1(KIM - 1)for acute kidney injury after coronary artery bypass surgery. Methods We retrospectively analyzed the clinical data of 182 patients who underwent off -pump coronary artery bypass surgery. The patients were divided into acute kidney injury(AKI)group(n = 23),and non - AKI(NAKI)group (n = 159). Serum Scr,BUN and urine Cys C and KIM - 1 were detected preoperatively and at 12 h,24 h,48 h,and 72 h postoperatively. The relationship between the changes of these parameters and acute kidney injury was analyzed. Results There was no significant difference in above mentioned parameters between AKI and NAKI groups before surgery( P ﹥ 0. 05). At 72h after surgery,serum levels of Scr and BUN in AKI group were relatively higher than those before the surgery and significantly different from those in NAKI group( P ﹤ 0. 05). In AKI group,urine Cys C level increased at 12 h,reached the peak at 24 h and decreased at 48 h after surgery;and significant differences were found between AKI and NAKI group( P ﹤ 0. 05). Meanwhile urine KIM - 1 level increased at 24 h,reached the peak at 48 h after surgery in AKI group and their levels were obviously higher than those in NAKI group( P ﹤ 0. 05). Conclusion The joint detection of Cys C and KIM - 1 early after the coro-nary artery bypass surgery is important for the diagnosis of AKI.