中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
6期
795-799
,共5页
急性肾损伤%中性粒细胞明胶酶相关脂质运载蛋白%早期诊断%冠状动脉旁路移植术
急性腎損傷%中性粒細胞明膠酶相關脂質運載蛋白%早期診斷%冠狀動脈徬路移植術
급성신손상%중성립세포명효매상관지질운재단백%조기진단%관상동맥방로이식술
Acute kidney injury%Neutrophil gelatinase-associated lipocalin%Early diagnosis%Coronary artery bypass grafting
目的 评价血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对非体外循环冠状动脉旁路移植(CABG)术后急性肾损伤(AKI)的早期诊断价值.方法 连续入选自2010年1月至2011年1月因确诊冠状动脉粥样硬化性心脏病入院,拟行择期非体外循环CABG治疗的患者231例.AKI定义为CABG术后48 h内最高血清肌酐绝对值升高≥0.3 mg/dl(26.4μmol/L),或较基线水平升高≥50％.用酶联免疫吸附试验方法检测术前及术后2h血浆NGAL水平,采用受试者工作特征曲线来评价其对AKI的诊断价值,诊断Cut-off值采用约登指数最大值对应的点.结果 231例患者中有37例(16.0％)发生AKI.发生AKI患者术前及术后2h血浆NGAL浓度分别为(69±25)和(112±29) μg/L,差异有统计学意义(P＜0.01);未发生AKI的患者术前和术后2h血浆NGAL浓度分别为(66±24)和(71 ± 21) μg/L,差异有统计学意义(P =0.004);所有患者术前血浆NGAL浓度差异无统计学意义(P=0.501),而发生AKI的患者术后2h血浆NGAL浓度明显高于未发生AKI的患者,差异有统计学意义(P＜0.01).术后2h血浆NGAL水平的药时曲线下面积最大为0.899(95％置信区间:0.843～0.954,P＜0.01).采用约登指数最大标准选择Cut-off值为85.6 μg/L,敏感性和特异性分别为0.865和0.851.结论 血浆NGAL可以作为非体外循环CABG术后发生AKI的早期诊断标志物.
目的 評價血漿中性粒細胞明膠酶相關脂質運載蛋白(NGAL)對非體外循環冠狀動脈徬路移植(CABG)術後急性腎損傷(AKI)的早期診斷價值.方法 連續入選自2010年1月至2011年1月因確診冠狀動脈粥樣硬化性心髒病入院,擬行擇期非體外循環CABG治療的患者231例.AKI定義為CABG術後48 h內最高血清肌酐絕對值升高≥0.3 mg/dl(26.4μmol/L),或較基線水平升高≥50％.用酶聯免疫吸附試驗方法檢測術前及術後2h血漿NGAL水平,採用受試者工作特徵麯線來評價其對AKI的診斷價值,診斷Cut-off值採用約登指數最大值對應的點.結果 231例患者中有37例(16.0％)髮生AKI.髮生AKI患者術前及術後2h血漿NGAL濃度分彆為(69±25)和(112±29) μg/L,差異有統計學意義(P＜0.01);未髮生AKI的患者術前和術後2h血漿NGAL濃度分彆為(66±24)和(71 ± 21) μg/L,差異有統計學意義(P =0.004);所有患者術前血漿NGAL濃度差異無統計學意義(P=0.501),而髮生AKI的患者術後2h血漿NGAL濃度明顯高于未髮生AKI的患者,差異有統計學意義(P＜0.01).術後2h血漿NGAL水平的藥時麯線下麵積最大為0.899(95％置信區間:0.843～0.954,P＜0.01).採用約登指數最大標準選擇Cut-off值為85.6 μg/L,敏感性和特異性分彆為0.865和0.851.結論 血漿NGAL可以作為非體外循環CABG術後髮生AKI的早期診斷標誌物.
목적 평개혈장중성립세포명효매상관지질운재단백(NGAL)대비체외순배관상동맥방로이식(CABG)술후급성신손상(AKI)적조기진단개치.방법 련속입선자2010년1월지2011년1월인학진관상동맥죽양경화성심장병입원,의행택기비체외순배CABG치료적환자231례.AKI정의위CABG술후48 h내최고혈청기항절대치승고≥0.3 mg/dl(26.4μmol/L),혹교기선수평승고≥50％.용매련면역흡부시험방법검측술전급술후2h혈장NGAL수평,채용수시자공작특정곡선래평개기대AKI적진단개치,진단Cut-off치채용약등지수최대치대응적점.결과 231례환자중유37례(16.0％)발생AKI.발생AKI환자술전급술후2h혈장NGAL농도분별위(69±25)화(112±29) μg/L,차이유통계학의의(P＜0.01);미발생AKI적환자술전화술후2h혈장NGAL농도분별위(66±24)화(71 ± 21) μg/L,차이유통계학의의(P =0.004);소유환자술전혈장NGAL농도차이무통계학의의(P=0.501),이발생AKI적환자술후2h혈장NGAL농도명현고우미발생AKI적환자,차이유통계학의의(P＜0.01).술후2h혈장NGAL수평적약시곡선하면적최대위0.899(95％치신구간:0.843～0.954,P＜0.01).채용약등지수최대표준선택Cut-off치위85.6 μg/L,민감성화특이성분별위0.865화0.851.결론 혈장NGAL가이작위비체외순배CABG술후발생AKI적조기진단표지물.
Objective To evaluate the neutrophil gelatinase-associated lipocalin (NGAL) for early diagnosis of acute kidney injury (AKI) after off-pump coronary artery bypass grafting (CABG) surgery.Methods Total 231 patients with coronary artery disease were continuously enrolled in our study from Jan.2010 to Jan.2011.All the patients had undergone off-pump CABG.AKI was defined as an absolute increase in serum creatinine of more than or equal to 0.3 mg/dl (≥ 26.4 μmol/L),or a percentage increase in serum creatinine of more than or equal to 50％ (1.5-fold from baseline) within 48 hours after surgery.Plasma NGAL at baseline and 2 hours after procedure were measured using ELISA kit.Receiver operation characteristic curve (ROC) was used to evaluate the diagnostic sensitivity and specificity.The Youden index was used to determine the Cut-off value for the biomarkers.Results Total of 231 patients were enrolled,among them 37 cases(16.0％) developed AKI.Among AKI patients,the plasma NGAL at baseline and 2 hours after procedure were (69 ± 25) μg/L and (112 ± 29) μg/L (P ＜0.01),respectively; while among non-AKI patients,the plasma NGAL was (66 ± 24)μg/L and (71 ± 21)μg/L (P =0.004),respectively.The plasma NGAL at baseline did not show any significant difference between AKI and non-AKI patients (P =0.501).But plasma NGAL at 2 hours after procedure among AKI patients was higher than that among non-AKI patients (P ＜0.01).The area under the ROC (AUC) of plasma NGAL at 2hours after surgery was 0.899 (95％ CI:0.843-0.954,P ＜ 0.01).The cut-off was 85.6 μg/L according to Youden index with 0.865 of sensitivity and 0.851 of specificity.Conclusion Plasma NGAL might be useful biomarker for early diagonosis of AKI after off-pump CABG.
