中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子1和白介素18在诊断心肺分流术后急性肾损伤中的意义  

Combination of urine neutrophil gelatinase lipocalin associated lipocalin, kidney injury molecular-1 and interleukin-18in the diagnosis of acute kidney injury in children after cardiopulmonary bypass

作　　者：刘华杰[1,2] 王平[1,2] 沈云琳[1,2] 李小兵[1,3] 张儒舫[1,3] 孙蕾[1,2] 匡新宇[1,2] 黄文彦[1,2] 

机构地区：[1]上海交通大学附属儿童医院 [2]上海市儿童医院肾脏风湿科,上海200040 [3]上海市儿童医院心胸外科,上海200040

出　　处：《临床儿科杂志》2014年第6期517-523,共7页Journal of Clinical Pediatrics

基　　金：国家自然科学基金项目(No.81370813);上海市科委基金项目(No.114119a1700);上海市卫生局优秀学科带头人项目(No.XBR2011010)

摘　　要：目的：探讨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）和白介素18（IL-18）在儿童心肺分流术（CPB）后急性肾损伤（AKI）临床诊断中的价值。方法随机收集2013年3月至2013年6月住院行CPB的先天性心脏病患儿67例，按照pRIFLE标准分为AKI组及非AKI组；观察术前，术后30 min、2 h、4 h、24 h、48 h和72 h血清肌酐（Scr）、尿NGAL、尿KIM-1、尿肌酐（Ucr）及尿IL-18水平。采用受试者工作特征曲线（ROC）及曲线下面积（AUC）评价NGAL、KIM-1及IL-18早期预测AKI的价值。结果67例CPB儿童中23例（34.3%）发生AKI。按pRIFLE标准分期：危险期15例，损伤期4例，衰竭期3例，丧失期1例。AKI组术后4 h、48 h和72 h尿NGAL/Ucr高于非AKI组，差异有统计学意义（P〈0.05）；术后4 h尿NGAL/Ucr为1.20时，预测AKI的灵敏度和特异度为0.864和0.561，AUC为0.671（95%CI：0.537~0.804）。术后48 h和72 h AKI组尿KIM-1/Ucr高于非AKI组，差异有统计学意义（P〈0.05）；CPB术后24 h尿KIM-1/Ucr为1.16时，预测AKI的灵敏度和特异度分别为0.773和0.512，AUC为0.698（95%CI：0.563~0.834）。术后4 h AKI组尿IL-18/Ucr高于非AKI组，差异有统计学意义（P〈0.05）；CPB术后4 h尿IL-18/Ucr为0.04时，预测AKI的灵敏度和特异度为0.773和0.561，AUC为0.655（95%CI：0.510~0.800）。结论联合检测尿NGAL、尿KIM-1及尿IL-18水平对儿童CPB术后早期预测AKI的发生可能具有重要的临床价值。Objective To investigate the values of urine neutrophil gelatinase associated lipocalin （NGAL）, kidney injury molecular-1 （KIM-1） and interleukin-18 （IL-18） in the diagnosis of acute kidney injury （AKI） in children after cardiopulmonary by-pass （CPB）. Methods Sixty-seven patients who had undergone CPB were recruited from March to June 2013 and assigned to acute kidney injury group （AKI group） or non-acute kidney injury group （non-AKI group） according to the pediatric RIFLE （pRIFLE） criteria. Serum and urine samples were collected from each patient at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h after CPB for serum and urine creatinine, urine NGAL, KIM-1 and IL-18. All the data were evaluated by receiver operator characteristic curve （ROC） analysis and area under curve （AUC） analysis. Results Twenty-three cases （34.3%） had AKI in 67 children after CPB. Among them 15 cases were risk-stage AKI, 4 cases injury-stage AKI, 3 cases failure-stage AKI and 1 cases loss-stage AKI. The levels of urine NGAL/Ucr were higher in AKI group than those in non-AKI group at 4h, 48h and 72h after CPB （P〈0.05）. The cut-off value of NGAL/Ucr was 1.200 at 4 h after CPB, the sensitivity and specificity for prediction of AKI were 0.864 and 0.561, and the AUC was 0.671 （95%CI：0.537-0.804）. The levels of urine KIM-1/Ucr were higher in AKI group than those in non-AKI group at 48h and 72 h after CPB （P〈0.05）. The cut-off value of KIM-1/Ucr was 1.162 at 24h after CPB, the sensitivity and specificity for prediction of AKI were 0.773 and 0.512, and the AUC was 0.698 （95%CI：0.563-0.834）. The levels of IL-18/Ucr were higher in AKI group than those in non-AKI group at 4 h after CPB （P〈0.05）. The cut-off value of IL-18/Ucr was 0.04 at 4 h after CPB, the sensitivity and specificity for prediciton of AKI were 0.773 and 0.561, and the AUC was 0.655 （95%CI：0.510-0.800）. Conclusions It is indicated that urine NGAL, KIM-1 and IL-18 may have important clinical values for early predicti

关 键 词：急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 肾损伤分子1 白介素18 儿童 

分 类 号：R726.5[医药卫生—儿科]