CAJ | 학술논문

目的探讨冠状动脉介入诊疗术后患者尿中性粒细胞明胶酶相关性载脂蛋白(NGAL)和肾损伤分子1(KIM-1)的变化,并评价两者在早期预测对比剂肾病(CIN)中的价值.方法采用前瞻性研究方法收集160例接受冠状动脉造影及介入治疗患者的临床资料.以术后发生CIN的患者作为CIN组(14例),以2∶1的比例选取未发生CIN的患者作为非CIN组(28例).检测两组患者术前和术后24、48、72 h血清肌酐水平,术前和术后4、24 h尿NGAL和KIM-1水平,分析NGAL、KIM-1与血清肌酐的关系.描绘受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评价尿NGAL和KIM-1诊断CIN的敏感度和特异度.结果 (1)术后4h,CIN组尿NGAL水平高于非CIN组(P＜0.01);CIN组尿NGAL水平高于术前基线水平(P＜0.01).(2)术后24 h,CIN组尿KIM-1水平高于非CIN组(P＜0.01);CIN组尿KIM-1水平高于术前基线水平(P＜0.01).(3)Pearson相关分析显示,CIN组患者尿NGAL水平与血清肌酐水平呈正相关(r=0.814,P ＜0.01),尿KIM-1水平也与血清肌酐水平呈正相关(r =0.758,P＜0.01).(4) ROC曲线显示,尿NGAL的曲线下面积为0.897,检测截断点为11.950μg/L时的敏感度和特异度分别为92.9％和71.4％;尿KIM-1曲线下面积为0.839,检测截断点为4.595μg/L时的敏感度和特异度分别为85.7％和71.4％.结论尿NGAL在冠状动脉介入诊疗术中使用对比剂后4h就能提示急性肾损伤,可能为较好的CIN早期生化标志物;尿KIM-1能较血清肌酐更早地反映肾功能的变化,在早期预测CIN中有一定的价值.
목적 탐토관상동맥개입진료술후환자뇨중성립세포명효매상관성재지단백(NGAL)화신손상분자1(KIM-1)적변화,병평개량자재조기예측대비제신병(CIN)중적개치.방법 채용전첨성연구방법수집160례접수관상동맥조영급개입치료환자적림상자료.이술후발생CIN적환자작위CIN조(14례),이2∶1적비례선취미발생CIN적환자작위비CIN조(28례).검측량조환자술전화술후24、48、72 h혈청기항수평,술전화술후4、24 h뇨NGAL화KIM-1수평,분석NGAL、KIM-1여혈청기항적관계.묘회수시자공작특정(ROC)곡선병계산곡선하면적(AUC),평개뇨NGAL화KIM-1진단CIN적민감도화특이도.결과 (1)술후4h,CIN조뇨NGAL수평고우비CIN조(P＜0.01);CIN조뇨NGAL수평고우술전기선수평(P＜0.01).(2)술후24 h,CIN조뇨KIM-1수평고우비CIN조(P＜0.01);CIN조뇨KIM-1수평고우술전기선수평(P＜0.01).(3)Pearson상관분석현시,CIN조환자뇨NGAL수평여혈청기항수평정정상관(r=0.814,P ＜0.01),뇨KIM-1수평야여혈청기항수평정정상관(r =0.758,P＜0.01).(4) ROC곡선현시,뇨NGAL적곡선하면적위0.897,검측절단점위11.950μg/L시적민감도화특이도분별위92.9％화71.4％;뇨KIM-1곡선하면적위0.839,검측절단점위4.595μg/L시적민감도화특이도분별위85.7％화71.4％.결론 뇨NGAL재관상동맥개입진료술중사용대비제후4h취능제시급성신손상,가능위교호적CIN조기생화표지물;뇨KIM-1능교혈청기항경조지반영신공능적변화,재조기예측CIN중유일정적개치.
Objective To explore the predict value of monitoring changes of urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) after coronary angiography (CAG) and percutaneous coronary intervention (PCI) on the early diagnosis of contrast-induced nephropathy (CIN).Methods One hundred and sixty patients underwent CAG and PCI were enrolled in this prospective study.There were 14 patients with CIN and non-CIN patients were selected with the proportion of 2∶1 (n =28).Serum creatinine (SCr) was measured before and at 24,48 and 72 h after the procedure.Urinary NGAL and KIM-1 were measured before and at 4 and 24 h after the procedure.The relationship between NGAL,KIM-1 and CIN were analyzed.Receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to analyze the diagnostic sensitivity and specificity of CIN by urinary NGAL and KIM-1.Results (1) The values of urinary NGAL was significantly higher in the CIN group than in non-CIN group at 4 h after CAG or PCI (P ＜ 0.01) ; the value of urinary NGAL was significantly increased from the baseline to 4 h after the procedure in the CIN group(P ＜ 0.01).(2) Uurinary KIM-1 levels of CIN group was significantly higher than in non-CIN group at 24 h after the CAG or PCI(P ＜0.01) ; the urinary KIM-1 levels was significantly increased from baseline to 24 h after the procedure in the CIN group(P ＜ 0.01).(3)Pearson correlation analysis showed that there was a positive correlation between urinary NGAL and SCr (r =0.814,P ＜ 0.01) and urinary KIM-1 (r =0.758,P ＜ 0.01) in the CIN group.(4) ROC curve analysis showed that the AUC for urinary NGAL was 0.897.When the cut-off value of NGAL was set at 11.950 μg/L,the sensitivity and specificity for the diagnosis of CIN were 92.9％ and 71.4％,respectively.The AUC for urinary KIM-1 was 0.839.With the cut-off value of urinary KIM-1 set as 4.595 μg/L,the diagnostic sensitivity and specificity for CIN were 85.7％ and 71.4％,respectively.Conclusions Urinary NGAL serves as a good biomarker for early diagnosis of CIN suggesting acute kidney injury at 4 h post CAG and PCI.Urinary KIM-1 can reflect the change of renal function after contrast injection earlier than SCr and may also be a good biomarker for early diagnosis of CIN.