中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
12期
1339-1343
,共5页
岳华%刘红%刘颖%赵志刚%陆晨%赵红娟%罗晶晶%茹仙古丽%陶建双%秦君玫%张总刚%肖东
嶽華%劉紅%劉穎%趙誌剛%陸晨%趙紅娟%囉晶晶%茹仙古麗%陶建雙%秦君玫%張總剛%肖東
악화%류홍%류영%조지강%륙신%조홍연%라정정%여선고려%도건쌍%진군매%장총강%초동
心脏手术%急性肾损伤%尿中性粒细胞明胶酶相关载脂蛋白%血肌酐
心髒手術%急性腎損傷%尿中性粒細胞明膠酶相關載脂蛋白%血肌酐
심장수술%급성신손상%뇨중성립세포명효매상관재지단백%혈기항
Heart surgery%Acute kidney injury%Urinary neutrophil gelatinase-associated lipocalin%Serum creatinine
目的 探讨尿中性粒细胞明胶酶相关载脂蛋白(NGAL)、尿肾损伤分子-1(Kim-1)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿胱蛋白酶抑制剂C(CystC)在成人心脏手术后急性肾损伤(AKI)早期诊断的敏感性及联合应用的临床价值.方法 选择2010年1月至2011年6月在我院心脏外科行心脏手术的住院患者105例,并收集手术前和手术后24、48、72 h的血、尿标本,分别测定尿NGAL、Kim-1、NAG、CystC及血肌酐,血肌酐较基础值增加≥50％的65例为AKI组,其余40例为非AKI组,观察两组患者尿NGAL、Kim-1、NAG、CystC的变化.尿NGAL、Kim-1、CystC测定采用酶联免疫法,尿NAG测定采用对硝基苯酚(PNP)比色法,血肌酐采用比浊法检测.并以受试者工作特征曲线及曲线下面积(AUC)评价各项标志物单独和联合应用时诊断AKI的价值.结果 两组患者术前血肌酐及尿NGAL、KIM-1、NAG及CystC比较差异均无统计学意义(P均＞0.05),AKI组的各项生物学标志物分别在术后24、48、72 h较非AKI组升高,差异存在统计学意义(P均＜0.001).与术前比较,AKI组尿NAG、CystC、NGAL、KIM-1术后24、48、72 h明显升高,差异均有统计学意义(P均＜0.001),联合以上4种尿生物标志物的最佳诊断时间点为术后48 h,得到的AUC为0.901(95％ CI 0.769～0.938).结论 心脏手术后AKI患者各项生物学标志物在术后不同的时间点显著升高,联合标记物的检测可以作为成人心脏手术后AKI的早期诊断方法.
目的 探討尿中性粒細胞明膠酶相關載脂蛋白(NGAL)、尿腎損傷分子-1(Kim-1)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿胱蛋白酶抑製劑C(CystC)在成人心髒手術後急性腎損傷(AKI)早期診斷的敏感性及聯閤應用的臨床價值.方法 選擇2010年1月至2011年6月在我院心髒外科行心髒手術的住院患者105例,併收集手術前和手術後24、48、72 h的血、尿標本,分彆測定尿NGAL、Kim-1、NAG、CystC及血肌酐,血肌酐較基礎值增加≥50％的65例為AKI組,其餘40例為非AKI組,觀察兩組患者尿NGAL、Kim-1、NAG、CystC的變化.尿NGAL、Kim-1、CystC測定採用酶聯免疫法,尿NAG測定採用對硝基苯酚(PNP)比色法,血肌酐採用比濁法檢測.併以受試者工作特徵麯線及麯線下麵積(AUC)評價各項標誌物單獨和聯閤應用時診斷AKI的價值.結果 兩組患者術前血肌酐及尿NGAL、KIM-1、NAG及CystC比較差異均無統計學意義(P均＞0.05),AKI組的各項生物學標誌物分彆在術後24、48、72 h較非AKI組升高,差異存在統計學意義(P均＜0.001).與術前比較,AKI組尿NAG、CystC、NGAL、KIM-1術後24、48、72 h明顯升高,差異均有統計學意義(P均＜0.001),聯閤以上4種尿生物標誌物的最佳診斷時間點為術後48 h,得到的AUC為0.901(95％ CI 0.769～0.938).結論 心髒手術後AKI患者各項生物學標誌物在術後不同的時間點顯著升高,聯閤標記物的檢測可以作為成人心髒手術後AKI的早期診斷方法.
목적 탐토뇨중성립세포명효매상관재지단백(NGAL)、뇨신손상분자-1(Kim-1)、뇨N-을선-β-D-안기포도당감매(NAG)、뇨광단백매억제제C(CystC)재성인심장수술후급성신손상(AKI)조기진단적민감성급연합응용적림상개치.방법 선택2010년1월지2011년6월재아원심장외과행심장수술적주원환자105례,병수집수술전화수술후24、48、72 h적혈、뇨표본,분별측정뇨NGAL、Kim-1、NAG、CystC급혈기항,혈기항교기출치증가≥50％적65례위AKI조,기여40례위비AKI조,관찰량조환자뇨NGAL、Kim-1、NAG、CystC적변화.뇨NGAL、Kim-1、CystC측정채용매련면역법,뇨NAG측정채용대초기분분(PNP)비색법,혈기항채용비탁법검측.병이수시자공작특정곡선급곡선하면적(AUC)평개각항표지물단독화연합응용시진단AKI적개치.결과 량조환자술전혈기항급뇨NGAL、KIM-1、NAG급CystC비교차이균무통계학의의(P균＞0.05),AKI조적각항생물학표지물분별재술후24、48、72 h교비AKI조승고,차이존재통계학의의(P균＜0.001).여술전비교,AKI조뇨NAG、CystC、NGAL、KIM-1술후24、48、72 h명현승고,차이균유통계학의의(P균＜0.001),연합이상4충뇨생물표지물적최가진단시간점위술후48 h,득도적AUC위0.901(95％ CI 0.769～0.938).결론 심장수술후AKI환자각항생물학표지물재술후불동적시간점현저승고,연합표기물적검측가이작위성인심장수술후AKI적조기진단방법.
Objective To explore the sensitivity and clinical value of combined detection of urine NGAL,Urine Kim-1,Urine NAG,urine Cystatin C in early acute kidney injury after adult cardiac surgery.Methods A hundred-five patients who underwent cardiac surgery in the department of heart surgery in the People's Hospital of the Xinjiang Uygur Autonomous Region from January 2010 to June 2011 were collected as subjects.Blood and urine specimens before operation and 24,48 and 72 hours after the operation were collected,urine NGAL,Kim-1,NAG,Cyst C and serum SCr levels were determined.According to AKI standard,65 patients were recruited into AKI group( serum SCr value increased by 50％ ),and the rest 40 patients were in non-AKI group.The changes of the parameters were recorded and analyzed.Urine NGAL,Kim-1,Cyst C were respectively determined by enzyme linked immuno sorbent assay (ELISA).The urine NAG was determined by nitro phenol (PNP) colorimetric detection.The SCr were detected by turbidity method.The individual and combined diagnostic values of these parameters for AKI were assessed using receiver-operating characteristic (ROC) curve and the area under the curve (AUC).Results There was no significant difference on SCr,NGAL,KIM-1,NAG and CystC between wo groups before operation (P ＞ 0.05 ),The level of each biological marker was significantly increased in AKI group than that in none AKI group at different time points after operation( P＜0.001 ).The levels of NAG,CystC,NGAL and KIM-1 in the AKI group were significantly higher at 24,48,and 72 hours after surgery than those before surgery ( P＜0.001 ).Giving a comprehensive evaluation,the above four parameters were at their best sensitivity at 48 hours after surgery,with an AUC of 0.901 (95％ CI;0.769 ～ 0.938).Conclusion The biological markers of AKI in heart surgery patients are significantly increased after operation.Joint marker detection can be used in the early diagnosis of AKI after adult heart surgery.
