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心脏术后尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素18与急性肾损伤的关系
引用本文:曹长春,万辛,肖雨龙,吴文芳,陈宇,陈鑫,穆心苇.心脏术后尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素18与急性肾损伤的关系[J].中华肾脏病杂志,2008,24(7):471-475.
作者姓名:曹长春  万辛  肖雨龙  吴文芳  陈宇  陈鑫  穆心苇
作者单位:1. 210006,南京医科大学附属南京第一医院肾内科
2. 210006,南京医科大学附属南京第一医院心胸外科
3. 210006,南京医科大学附属南京第一医院ICU
基金项目:国家自然科学基金,江苏省南京市医学科技发展基金 
摘    要:目的 探讨接受体外循环心脏手术患者尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿白细胞介素18(IL-18)与急性肾损伤(AKI)的关系。 方法 根据AKI的诊断标准,将33例体外循环心脏手术的患者分为AKI组及非AKI组,分别留取术前及术后不同时间点的血液和尿液标本,测定Scr、尿NGAL和IL-18水平。 结果 33例中有9例发生AKI,发生率为27.27%。AKI组Scr升高峰值出现在12~48 h内。与术前相比, AKI组术后2 h、4 h尿NGAL及IL-18水平升高,差异有统计学意义(P < 0.01)。与非AKI组比较,AKI组术后各时间点的尿NGAL水平、术后2 h及4 h的尿IL-18水平都较高,差异有统计学意义(P < 0.01)。经尿肌酐(Ucr)校正后,相应时间点的NGAL/Ucr和IL-18/Ucr差异仍有统计学意义(P < 0.01)。术后2 h尿NGAL和尿NGAL/Ucr的界定(cutoff) 值分别在250 µg/L和250 µg/mmol时;术后2 h尿IL-18和尿IL-18/Ucr的界定值分别在1800 ng/L和1800 ng/mmol时,体现出较好的敏感性和特异性。 AKI组术后12 h Scr水平与术后2 h尿NGAL水平呈正相关(r = 0.638,P < 0.05)。结论 体外循环下接受心脏手术的患者AKI发生率较高;术后2 h尿NGAL和NGAL/Ucr、术后2 h尿IL-18和尿IL-18/Ucr当达到一定界定值时,均可作为体外循环下心脏手术后AKI发生的早期诊断参考指标,其中术后2 h尿NGAL/Ucr为250 µg/mmol时更敏感。

关 键 词:急性肾损伤    白细胞介素18    粒细胞明胶酶相关脂质运载蛋白    心脏手术
收稿时间:2008-1-9

Association of urinary neutrophil gelatinase-associated lipocalin and interleukin 18 with acute kidney injury after cardiac surgery
CAO Chang-chun,WAN Xin,XIAO Yu-long,WU Wen-fang,CHEN Yu,CHEN Xin,MU Xin-wei.Association of urinary neutrophil gelatinase-associated lipocalin and interleukin 18 with acute kidney injury after cardiac surgery[J].Chinese Journal of Nephrology,2008,24(7):471-475.
Authors:CAO Chang-chun  WAN Xin  XIAO Yu-long  WU Wen-fang  CHEN Yu  CHEN Xin  MU Xin-wei
Institution:Department of Nephrology, the First Hospital Affiliated of Nanjing Medical University, Nanjing 210006, China
Abstract:Objective To examine the association of urinary neutrophil gelatinase-associated lipocalin(NGAL) and interleukin 18(IL-18) with acute kidney injury (AKI) in patients after cardiac surgery. Methods Thirty-three patients undergone cardiac surgery were divided into AKI group and non-AKI group according to the AKI criteria. The Scr, urinary NGAL and IL-18 were measured at different time points. Results Nine of 33 patients (27.27%)developed postoperative AKI, and Scr concentration in AKI group reached its peak within 12-48 hours after cardiac surgery. Urinary concentrations of NGAL and IL-18 at 2 h and 4 h after cardiac surgery were significantly higher than those before operation in AKI patients (P<0.01). The urinary concentrations of NGAL at each time point and that of IL-18 at 2 h and 4 h after cardiac surgery in AKI patients were significantly higher than those in non-AKI patients. After correction by urinary creatinine, the differences of NGAL/Ucr and IL-18/Ucr ratios were still significant (P< 0.01). For concentrations of urinary NGAL, IL-18 and ratios of NGAL/Ucr, IL-18/Ucr at 2 h after surgery, sensitivities and specificities were good with cutoff values at 250 μg/L, 250 μg/mmol and 1800 ng/L, 1800 ng/mmol, respectively. Urinary concentration of NGAL at 2 h after cardiac surgery was positively correlated with Scr at 12 h postoperation in AKI group (r=0.638, P<0.05).Conclusions The incidence of AKI in patients after cardiac surgery is quite high. Urinary concentrations of NGAL, IL-18 and ratios of NGAL/Ucr, IL-18/Ucr at 2 h after cardiac surgery are the early diagnostic markers for AKI, among which urinary NGAL/Ucr is the most sensitive one.
Keywords:Interleukin 18  Acute kidney injury  Neutiophil gelatinase-associated lipocalin  Cardiac surgery
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