中性粒细胞明胶酶相关脂质运载蛋白和肾损伤分子-1在成年人心脏手术后急性肾损伤早期诊断中的价值

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）和血清肌酐在成年人心脏手术后急性。肾损伤（AKI）早期诊断中的价值。方法收集65例行心脏外科手术患者术前及术后24、48、72h的血、尿标本，检测血清肌酐及尿NGAL、KIM-1，其中发生AKI（AKI组）34例，未发生AKI（非AKI组）31例，并与20例健康体检者（对照组）进行比较。采用Logstic回归模型判断血清肌酐及尿NGAL、KIM．1的早期诊断价值。结果心脏手术后AKI的发生率为52.31％（34／65）。AKI组和非AKI组术前及术后24、48、72h血清肌酐及尿NGAL、KIM．1均明显高于对照组[血清肌酐：（62．44±22．26）、（77．38±24．38）、（98．24±25．02）、（98．14±45．26）μmol／L和（56．67±21．68）、（59．25±15．58）、（55．40±22．91）、（40．10±23．45）¨mol／L比（16．43±5．01）斗mol／L，尿NGAL：（4．81±0．65）、（9．48±3．29）、（11．87±3．93）、（7．66±1．52）μg／L和（4．67±0．53）、（8．89±2．64）、（11．46±3．60）、（7．47±1．63）μg／L比（2．87±0．48）μg／L，尿KIM-1：（47．93±5．54）、（61．89±12．44）、（100．21±27．32）、（67．69±8．72）μg／L和（47．12±4．08）、（56．38±9．27）、（90．14±27．26）、（69．40±8．90）μg/L比（32．21±12．54）μg／L]，差异有统计学意义（P〈0．01）；AKI组和非AKI组术后24、48、72h尿NGAL、KIM-1明显高于术前，差异有统计学意义（P〈0．01）；AKI组术后24h血清肌酐及尿NGAL、KIM．1均明显高于非AKI组，差异有统计学意义（P〈0．01）。术后24h尿NGAL、KIM-1诊断AKI的敏感度和特异度与血清肌酐比较差异无统计学意义（P〉0．05）。结论接受体外循环心脏手术的成年人术后AKI发生率高；术后24h对于传统诊断金标准的血清肌酐与早期生物学标记物尿NGAL、KIM-1在诊断AKI上具有相似的敏感度和特异度。

Value of neutrophils gelatinases related lipid a carrier protein and renal injury molecule-1 for early diagnosis in adult cardiac surgery after acute renal injury

Objective To explore the value of neutrophils gelatinases related lipid a carrier protein （NGAL）, renal injury molecule-1 （K1M-1 ） and serum creatinine （SCr） for early diagnosis in adult cardiac surgery after acute renal injury （AKI）. Methods Blood and urine samples of 65 cardiac surgery patients before and 24,48,72 h after surgery were collected, SCr,urine NGAL and KIM-1 levels was detected, among whom AKI occurred in 34 cases（AKI group）, did not occur in 31 cases （non AKI group）, and theywere compared with 20 cases of healthy physical examination （control group）. Logistic regression model was used to judge the value of early diagnosis of SCr,urine NGAL and KIM-1. Results The incidence of AKI after cardiac surgery was 52.31% （34/65）. The SCr, urine NGAL and KIM - 1 levels in AKI group and non AKI group before and 24 , 48 , 72 h after surgery were significantly higher than those in control group [ SCr： （62.44 ±22.26）, （77.38 ±24.38）, （98.24 ±25.02）, （98.14 ±45.26）μmol/L and （56.67 ±21.68）, （59.25 ± 15.58）, （55.40 ±22.91）, （40.10 ±23.45）μmol/L vs. （16.43 ±5.01）μmol/L;urine NGAL： （4.81 ±0.65）, （9.48 ±3.29）, （11.87 ±3.93）, （7.66 ± 1.52） μg/L and （4.67 ±0.53）, （8.89 ±2.64）, （11.46 ± 3.60）, （7.47 ± 1.63） μg/L vs.（2.87 ± 0.48） μg/L; KIM - 1：（47.93 ± 5.54）, （61.89 ± 12.44）, （ 100.21 ± 27.32）, （67.69 ± 8.72） μ g/L and （47.12 ± 4.08）, （56.38 ± 9.27）, （90.14 ± 27.26）, （69.40 ± 8.90） μ g/L vs. （32.21± 12.54） μ g/L] （P 〈 0.01 ）. Urine NGAL and KIM-1 levels in AKI group and non AKI group 24 ,48 ,72 h after surgery were significantly higher than those before surgery （P 〈 0.01 ）. SCr, urine NGAL and KIM-1 levels in AKI group 24 h after surgery were significantly higher than those in non AKI group （P〈 0.01 ）. Twenty-four hours after surgery,the sensitivity and specificity of urine NGAL, KIM-1 in the diagnosis of AKI, compared with that of SCr had no statistical significance （P 〉 0.05 ）. Conclusions The adults who accept extraeorporeal circulation cardiac surgery appear high incidence of AKI. Twenty-four hours after surgery, early biological markers- urine AKI,KIM-1 ,has similar sensitivity and specificity with traditional diagnostic gold standard of SCr.