NGAL 和HO-1 在瓣膜置换术致急性肾损伤中的临床意义及干预研究

目的：分析风湿性心脏瓣膜病择期行瓣膜置换术的患者术后急性肾损伤(acute kidney injury，AKI)发生情况并术中行下肢缺血处理，探讨瓣膜置换术所致心-肾综合征(cardio-renal syndrome，CRS)的发病机制及其预防措施。方法：入选46例风湿性心脏瓣膜病择期行瓣膜置换术的患者，随机分为对照组(Con)16例，远隔缺血时处理组(remoteischemic perconditioning，RIPerC)15例，远隔缺血后处理组(remote ischemic postconditioning，RIPostC)15例。比较3组患者术前、开放主动脉后6，12，24，48 h血肌酐、尿素氮、血红素氧合酶-1(heme oxygennase-1，HO-1)、血清铁及尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin，NGAL)水平变化。结果：与术前基础值相比，对照组、RIPerC组及RIPostC组患者术后血肌酐，尿素氮，尿NGAL，血清铁(6，12 h)，血HO-1均显著升高(P<0.05)。与对照组相比，RIPerC组及RIPostC组开放主动脉后6，12，24，48 h，血HO-1均显著升高，其中RIPerC组12，24，48 h的血HO-1水平，RIPostC组24，48 h的血HO-1水平差异有统计学意义(P<0.05)；与对照组相比，RIPerC组及RIPostC组开放主动脉后6，12，24，48 h血肌酐、尿素氮、尿NGAL、血清铁均降低，但各组间差异均无统计学意义(P>0.05)。结论：瓣膜置换术后尿NGAL、血清铁、血HO-1的异常改变有望作为术后AKI发生的早期预警指标；远隔缺血处理方法对瓣膜置换术所致CRS具有良好的预防及肾保护作用。

Intervention of NGAL and HO-1 in valve replacement surgery-induced acute kidney injury

Objective: To determine the pathological mechanism and prevent heart-renal syndrome after heartvalve replacement surgery.Methods: A total of 46 patients were admitted for selective valve replacement, and divide into3 groups randomly: a control group (Con, n=16), a remote ischemic perconditioning (RIPerC)group (n=15) and a remote ischemic postconditioning (RIPostC) group (n=15). The serumcreatinine (SCr), blood urea nitrogen (BUN), serum heme oxygennase-1 (HO-1), serum iron andurinary neutrophil gelatinase associated lipocalin (NGAL) level in the 3 groups were comparedpreoperatively and 6, 12, 24, 48 h after aortic cross-release.Results: Compared with the preoperative level, the SCr, BUN, urinary NGAL, serum iron (6 and12 h) and serum HO-1 values were significantly increased after the heart valve replacement surgeryin the control patients, RIPreC and RIPostC groups (P<0.05). Compared with the control group,the serum HO-1 was significantly increased at 6, 12, 24, 48 h after the heart valve replacementsurgery in both the RIPerC and RIPostC groups (P<0.05); the SCr, BUN, urinary NGAL andserum iron values were decreased at 6, 12, 24, 48 h after the heart valve replacement surgery in boththe RIPerC and RIPostC groups (P>0.05).Conclusion: Abnormal change in urinary NGAL, serum iron and HO-1 can be used as earlywarning indicators of acute kidney injury when cardio-renal syndrome occurrs among patientsunder heart valve replacement surgery. Remote ischemic conditioning plays a preventive role in theoccurrence of cardio-renal syndrome and renal protection.