婴幼儿先天性心脏病体外循环术后急性肾损伤早期预警的临床研究  

Early prediction of acute kidney injury in infants and young children after cardiopulmonary bypass surgery

作　　者：肖燕燕[1] 郑建勇[1] 姚勇[2] 徐国宾 金梅[1] 刘迎龙[1] 韩玲[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科,100029 [2]北京大学第一医院儿科 [3]检验科

出　　处：《中华儿科杂志》2013年第10期765-770,共6页Chinese Journal of Pediatrics

基　　金：首都医学发展科研基金（2009-3112）

摘　　要：目的探讨婴幼儿先天性心脏病体外循环术后急性肾损伤的发病情况以及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白介素18（IL-18）及N-乙酰-B—D氨基葡萄糖苷酶（NAG）、尿微量白蛋白（MA）、仅1微球蛋白（α1-MG）在婴幼儿先天性心脏病体外循环术后急性。肾损伤中的早期预测价值。方法本组58例≤3岁的行体外循环手术的先天性心脏病患儿，分别在术前和体外循环开始后4、6、12、24h留取尿样进行NGAL、IL-18、NAG、MA、d1-MG的检测。根据体外循环术后是否发生急性肾损伤分为急性肾损伤组和非急性肾损伤组，对2组以上指标进行比较。结果急性肾损伤组和非急性肾损伤组各29例，两组性别、年龄、体重差异无统计学意义。急性肾损伤组术后4、6、12h的尿NGAL／尿肌酐（UCr）水平（2820．0μg／g，905．7斗∥g，76．1μg/g）均高于非急性肾损伤组（27．6μg/g，19．5μg／g，16．0μg／g）（P〈0．01）。急性肾损伤组术后4、6、12和24h的尿IL-18／UCr水平（3768．0ng／g，1092ng／g，421．0ng／g，256．8ng／g）均高于非急性肾损伤组（511．7ng／g，304．1ng／g，207．5ng／g，100．8ng／g）（P〈0．05）。急性肾损伤组术后4、6h的尿NAG／UCr水平（1205．5U／g，294．7U／g）均高于非急性肾损伤组（176．8U／g，104．5U／g）（P〈0．01）。急性肾损伤组术后4、6、12h的尿MA／UCr水平（1628．0m∥g，383．7mg/g，121．2mg／g）均高于非急性肾损伤组（119．0mg／g，81．3mg／g，86．5mg／g）（P〈0．05）。急性肾损伤组术后4、6、12h的尿d1-MG／UCr水平（804．4mg／g，384．5mg／g，104．4mg／g）高于非急性肾损伤组（154．0mg／g，84．3mg／g，37．2mg／g）（P〈0．01）。尿NGAL、IL．18、NAG、MA／UCr和ctl．MG／UCr5个指标均在术后4h预测价值最大。结论尿生物学标志物NGAL、IL-18、NAG、MA、a1-MG对体外循环术后早期急Objective To understand the incidence of acute kidney injury （AKI） in infants and toddlers and evaluate the possibility of predicting AKI with urine neutrophil gelatinase-associated lipocalin （ NGAL）, interleukin 18 （ IL-18 ）, N-acetyl-beta-D-glucosaminidase （ NAG）, microalbumin （ MA ） and etl - microglobulin （α1-MG） after surgeries for congenital heart diseases with cardiopulmonary bypass （CPB）. Method Fifty-eight children （ages 〈 3 years ） who had undergone surgery for congenital heart diseases with CPB were enrolled. Urinary samples were collected before and 4 h ,6 h, 12 h ,24 h post CPB to detect the concentration of NGAL, IL-18, NAG, MA and ctl-MG. Result The AKI group had 29 cases, none AKI group also had 29 cases. Urinary concentration of NGAL 4,6, and 12 h post CPB were significantly higher in AKI group （2820 Ug/g,905.7 Ixg/g,76. 1 Ug/g separately） than in none AKI group （27.6 Ug/g,19. 5 Ug/g, 16.0 Ug/g separately, P 〈 0.01 ）.Urinary concentration of IL-18 4,6, 12 and 24 h post CPB were significantly higher in AKI group than in none AKI group （ P 〈 0. 05 ）. Urinary concentration of NAG 4 h and6 h post CPB were significantly higher in AKI group than in none AKI group （ P 〈 0. 01 ） . Urinary concentration of MA/UCr post CPB 4 h,6 h and 12 h were significantly higher in AKI group than in none AKI group （P 〈 0. 05 ）. Urinary concentration of ctl-MG/UCr post CPB 4 h,6 h and 12 h were significantly higher in AKI group than in none AKI group （P 〈0. 01 ）. All the five biomarkers had predictive abilities at 4-hour after surgery. Conclusion Urine biomarkers NGAL, IL-18, NAG, MA and ctl-MG were valuable early predictors of AKI after CPB surgery.

关 键 词：婴儿 儿童 体外循环 预测 急性肾损伤 

分 类 号：R726.5[医药卫生—儿科]