尿肾脏损伤分子1、白细胞介素18和胱抑素C对老年钆造影剂肾病的预测价值  

Prognostic value of urinary kidney injury molecule 1, interleukin 18 and cystatin C as biomarkers for gadoliniam- based contrast-induced nephropathy in the elderly patients

作　　者：余振球[1] 段绍斌[1] 周顺科[2] 潘鹏[1] 刘改灵[1] 孙林[1] 彭佑铭[1] 刘伏友[1] 

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011 [2]中南大学湘雅二医院放射科,长沙410011

出　　处：《中华肾脏病杂志》2013年第3期173-177,共5页Chinese Journal of Nephrology

基　　金：基金项目：湖南省科技厅科技攻关项目（2010FJ6008）

摘　　要：目的探讨尿肾脏损伤分子1（KIM-1）、白细胞介素18（IL-18）和胱抑素C（CysC）对老年钆造影剂肾病（Gd．CIN）的预测价值。方法选取2010年12月至2011年12月在中南大学湘雅二医院因核磁共振检查使用钆造影剂的老年患者60例，收集患者造影前和造影后第24、48h的血清和尿标本。采用酶联免疫吸附法（ELISA）检测尿液中KIM-1、IL-18和CysC水平，全自动生化分析仪检测血肌酐和尿肌酐。结果60例静脉注射钆造影剂患者中8例发生Gd．CIN，发生率为13-3％。与造影前基础值比较，造影后24hGd—CIN组患者尿KIM—1、IL-18和CysC水平均明显增高（P〈0．05）；造影后24hGd．CIN组尿KIM-1、IL-18和CysC水平及造影后48h尿IL-18水平均显著高于非Gd—CIN组（均P〈0．05）；造影后48hGd—CIN组尿KIM-1、CvsC水平与非Gd—CIN组比较差异无统计学意义（均P〉0．05）。多因素Logistic回归分析显示造影后24h尿KIM-1、IL-18水平是造影后Gd—CIN发生的独立预测指标（OR=1．612、1．009，均P〈0．05）：尿KIM-1、IL-18和Cys C水平较Scr升高提前。结论尿KIM-1、IL-18和CysC水平检测对核磁共振检查老年患者早期诊断Gd—CIN有重要预警价值。Objective To assess the prognostic values of urinary kidney injury molecule 1 （KIM- 1）, interleukin 18 （IL- 18） and cystatin C （Cys C） for gadolinium- based contrast- induced nephropathy （Gd- CIN） in the elderly patients. Methods A total of sixty elderly patients who underwent enhanced magnetic resonance imaging （MRI） using gadolinium-based contrast media （GBC） from December 2010 to December 2011 were enrolled. Serum and urine samples were collected before and after the procedure. The levels of urinary KIM- 1, IL- 18 and Cys C were measured by ELISA respectively. Serum and urine ereatinine levels were measured by automatic biochemical analyzer. Results Among 60 patients, Gd-CIN was diagnosed in 8 （13.3%） patients. At 24 h after MRI in the Gd-CIN group, the levels of urinary KIM-1, IL-18 and Cys C were significantly increased compared with the baseline values. Compared with non-Gd-CIN group, the levels of urinary KIM-1, IL-18 and Cys C at 24 h and urinary IL-18 at 48 h after GBC administration were significantly increased （P 〈 0.05）. There were no significant differences in levels of urinary KIM- 1, Cys C at 48 h after GBC administration between Gd-CIN and non-Gd-CIN group （P 〉 0.05）. Logistic regression analysis showed that the levels of urinary KIM - 1 and IL- 18 at 24 h after GBC injection were independent predictive biomarkers of Gd-CIN （OR = 1.612, 1.009, all P 〈 0.05）. The predictable time of acute kidney injury onset determined by urinary KIM- 1, IL- 18 and Cys C levels was 24 h earlier than that by serum creatinine. Conclusion Urinary KIM- 1, IL-18 and Cys C may be early predictive biomarkers of elderly Gd- CIN, which shows a good performance in early diagnosis of Gd- CIN as compared with serum creatinine.

关 键 词：磁共振成像 肾疾病 造影剂 钆 生物学标志物 

分 类 号：R692[医药卫生—泌尿科学]