生物标志物组联合检测对心脏手术后急性肾损伤早期诊断检验效能研究  

Power of test of biomarker panel on early diagnosis of post cardiac operative acute kidney injury

作　　者：张璐[1] 张文[1] 瞿晓红[2] 倪莉燕[1] 顾志冬[3] 赵强[2] 陈楠[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025 [2]上海交通大学医学院附属瑞金医院心脏外科,上海200025 [3]上海交通大学医学院附属瑞金医院检验科,上海200025

出　　处：《中国实用内科杂志》2013年第3期210-213,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81070586);上海市科委基金(10411965900);上海市科委基础重点基金(11JC1407900)

摘　　要：目的检测并评价手术后急性肾损伤(PO-AKI)患者尿液中巢蛋白(nestin)、中性粒细胞明胶酶相关性脂质运载蛋白(NGAL)、尿损伤因子(KIM-1)、视黄醇结合蛋白(RBP)4种生物标志物对于急性肾损伤(AKI)早期诊断的检验效能。方法以2011年10月上海交通大学医学院附属瑞金医院心脏外科手术后的40例患者作为研究对象,其中男28例,女12例;年龄24～79岁,平均(56.15±12.83)岁。根据急性肾损伤网络工作小组(AKIN)定义分为AKI组和非AKI组。尿液生物标志物组的检测采用酶联免疫法(ELISA),同时检测实时尿肌酐值。结果 AKI发生率为25%(10/40),其中AKIN 1级7例、2级1例、3级2例,3级中2例均进行了肾脏替代治疗(RRT)。联合生物标志物组nestin、NGAL、KIM-1、RBP对于AKI的检测在24 h时间窗内明显升高(P<0.05),并且经尿肌酐(Ucr)校正后在6 h内升高更加显著(P<0.05)。结论联合生物标志物组对于AKI的检测在24 h内明显升高,经过Ucr校正后6 h升高趋势更加一致,对于早期判断AKI具有预警作用。Objective To assess the power of test of the biomarker panel, namely, nestin, neutrophil gelatin enzyme correlation lipid carrier protein （NGAL） ,kidney injury molecule-1 （KIM-1） ,retinol binding protein （RBP） for early diagnosis of acute kidney injury in patients who had undergone cardiac surgery. Methods Forty patients （28 males and 12 females, mean age： [ 56. 15 ± 12. 83 ] years） who had underwent cardiac surgery were recruited from the department of cardiac surgery,Affiliated Ruijin Hospital of Shanghai Jiaotong University in October 2011 and assigned to acute kidney injury group （group AKI） or non-acute kidney injury group （group non-AKI）, on the basis of the definition by acute kidney injury network （AKIN）. Urine samples were analyzed by Enzyme linked immunosorbent assay（ELISA） was employed to determine the levels of urine biomarker panel and the real-time urine creatinine. Results The incidence of AKI was 25% （ 10/40）, including 7 cases with stage 1 AKI, 1 with stage 2 AKI, and 2 with stage 3 AKI. Two out of 3 subjects with stage 3 AKI received renal replacement therapy （RRT）. The biomarker panel, when referred to as nestin, NGAL, KIM- and RBP, increased significantly （ all P 〈 0. 05 ） within 24 hours and,when adjusted for urine creatinine （Ucr） , elevated more impressively in 6 hours （ all P 〈 0.05）. Conclusion Featured by a considerable increase within 24 hours of AKI, the biomarker panel may be more significantly elevated within 6 hours of onset when adjusted for urine creatinine level and may alert physicians of the occurrence of AKI in a timely fashion.

关 键 词：急性肾损伤 生物标志物 巢蛋白 中性粒细胞明胶酶相关性脂质运载蛋白 尿损伤因子 视黄醇结合蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]