尿N-乙酰-β-D氨基葡萄糖酐酶和视黄醇结合蛋白在冠状动脉介入术后的变化及早期预测造影剂肾病的价值  

The difference of urinary N.acetyl-β-D-glucosaminidase and retinol binding protein before and after coronary angiography and their predictive values in contrast induced nephropaty.

作　　者：王玲[1] 倪兆慧[2] 何奔[2] 刘建平[2] 杜勇平[2] 宋玮[2] 卜军[2] 戴惠莉[1] 吴青伟[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科,200127 [2]上海交通大学医学院附属仁济医院心内科,200127

出　　处：《中国综合临床》2009年第9期904-907,共4页Clinical Medicine of China

基　　金：浦东新区社会发展局卫生科技项目（PW2007D-3）;仁济医院-基础医学院合作研究基金项目（PY07008）

摘　　要：目的前瞻性研究冠状动脉介入诊疗术后，尿N-乙酰-β-D氨基葡萄糖酐酶（UNAG）和尿视黄醇结合蛋白（URBP）在造影剂所致急性肾损伤发生前后的差异。方法收集150例接受冠状动脉造影及介入治疗患者的临床资料。留取患者术前、术后24h、术后48—72h尿液和血液。用酶法测血清肌酐（SCr）和尿肌酐（UCr）值；用ELISA法检测UNAG和URBP水平。手术后48～72hSCr上升基础值的25％或绝对值上升44μmol／L以上诊断为造影剂肾病（CIN）13例，选择性别、年龄、冠状动脉造影结果等基础资料匹配的27例为对照组。结果接受冠状动脉造影及介入治疗患者的CIN发病率为8．7％（13／150）。CIN组术前UNAG／UCr水平明显高于对照组[1．97（1．06，2．64）U／mmol与1．07（0．68，1．88）U／mmol，Z=2．076，P=0．039]；术后24hCIN组患者UNAG／UCr值较术前显著上升[2．82（1．88，4．26）U／mmol与1．97（1．06，2．64）U／mmol，Z=2．607，P=0．009]；ROC分析显示术前基础UNAG值可用于CIN预测，曲线下面积达0．776（P=0．023）；截断值为8．08U／L时，诊断的敏感性和特异性分别为0．771和0．713。基线UNAG高于8．08U／L的比例在CIN组中明显高于对照组[77．1％（10／13）与29．6％（8／27），Z=2．564，P=0．011]，与发病的相对危险度为5．58，95％口为1．24—25．08。结论UNAG检测可用于CIN患病危险度的预测，并且术后24h水平可用于CIN的早期诊断。Objective To prospectively study the difference of urin.ary N-acetyl-β-D-glucosaminidase（ UN- AG） and retinol binding protein（URBP） in contrast-induced nephropathy （CIN）. Methods The clinical data of 150 patients undergoing coronary angiography were documented. The urine and blood samples before,24 hours after and 48 - 72 hours after the procedure were collected; Serum creatinine （SCr） and urinary creatinine （UCr）were tested by enzymic method. UNAG and URBP were tested by ELISA in CIN and control group. CIN was defined as an increase in SCr of ≥44 μmol/L or 〉25% from baseline 48 -72 h after the procedure. 27 age-,sex-,resuhs of coronary angiography-matched cases were taken as control group. Results CIN was diagnosed in 13 of 150 patients （ 8.7 % ）. In CIN group, UNAG/UCr were significantly higher than that in control group [ 1.97 （1.06,2.64） U/mmol vs 1.07 （0.68,1.88） U/mmol, Z = 2.076, P = 0.039 ] before ;24 hours after the procedure, UNAG/UCr was significantly up-regulated in CIN group from baseline level [ 2.82 （1.88,4.26） U/mmol vs 1.97 （1.06,2.64） U/mmol, Z = 2. 607, P = 0.009 ]. ROC curve analysis showed that baseline UNAG could be used as an early predictor for CIN,the AUC = 0. 776, P = 0.023 ;when cut off value = 8.08 U/L, the sensitivity and specificity of UNAG were 0.771 and 0.713 respectively. The percentage of patients of UNAG over 8.08 U/L in CIN group was significantly higher than that in control group[ 77.1% （ 10/13 ） vs 29.6% （ 8/27 ）, Z = 2. 564, P = 0.011 ] , the related risk factor is 5.58,95% Cl was 1.24 - 25.08. Conclusion UNAG could be used as a predictor of CIN before the procedure and its postprocedure 24 h level maybe useful in early diagnosis after the procedure.

关 键 词：尿N-乙酰-β-D氨基葡萄糖酐酶 尿视黄醇结合蛋白 造影剂肾病 冠状动脉造影术 

分 类 号：R692.9[医药卫生—泌尿科学] R543.3[医药卫生—外科学]