急性失代偿性心力衰竭合并急性肾损伤的早期诊断研究  

Study on early diagnosis of acute decompensated heart failure combined with acute renal injury

作　　者：袁方[1] 刘华[1] 王雯霞[1] 戴锦杰[1] 戴丽莹[1] 杨潇潇[1] 方唯一[1] 

机构地区：[1]上海交通大学附属胸科医院心内科,上海200030

出　　处：《上海交通大学学报（医学版）》2014年第12期1771-1774,1779,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市卫生局科研项目(20114324)~~

摘　　要：目的评价新型急性肾损伤(AKI)的生物标志物对急性失代偿性心力衰竭(ADHF)合并AKI即1型心肾综合征(CRS1)的早期诊断价值。方法入选ADHF患者200例,测基线血清肌酐(Scr)、血清组合[中性粒细胞明胶酶相关脂质运载蛋白(NAGL)、胱蛋白酶抑制剂C(Cys C)]、尿液组合[(NAGL、肾损伤分子1(KIM-1)],6 h和18 h分别复测血清组合和尿液组合,48 h后复测Scr。根据CRS1诊断标准筛选出CRS1患者,分析血清及尿液NAGL、血清Cys C、尿液KIM-1与Scr的相关性;根据受试者工作特征(ROC)曲线得到6 h和18 h时NAGL、Cys C、KIM-1诊断AKI的诊断界值、灵敏度、特异度及ROC曲线下面积(AUC);分别计算6 h和18 h血清组合(NAGL、Cys C)、尿液组合(NAGL、KIM-1)检测AKI的AUC。结果根据CRS1的诊断标准,200例ADHF患者中48例发生AKI,发生率为24%。6 h血清NAGL、18 h血清Cys C分别与Scr呈正相关(r=0.857,P<0.05;r=0.869,P<0.05);6 h尿液NAGL、KIM-1与Scr呈正相关(r=0.756,P<0.05;r=0.742,P<0.05)。联合检测6 h和18 h血清组合的AUC为0.87和0.89;联合检测6 h和18 h尿液组合的AUC为0.92和0.93。结论血清、尿液NAGL及血清Cyc C、尿液KIM-1可作为CRS1患者的早期诊断标志物;联合检测尿液NAGL和KIM-1可提高CRS1早期诊断的敏感度和特异度。Objective To evaluate the value of new biological indicators of acute kidney injury（AKI） for early diagnosis of acute decompensated heart failure（ADHF） combined with AKI,i.e.cardiorenal syndrome type 1（CRS1）.Methods A total of 200 patients with ADHF were enrolled.Levels of baseline serum creatinine（SCr）,serum combination[neutrophil gelatinase associated lipocalin（NAGL） and Cystatin C（CysC）],and urine combination[NAGL and kidney injury molecule-1（KIM-1）]were detected.Levels of serum combination and urine combination were redetected after 6 h and 18 h and the level of SCr was redetected after 48 h.According to the criteria,C RS1 patients were selected.The correlations of serum and urine NAGL,serum CysC,urine KIM-1,and Scr were analyzed.According to receiver operating characteristic（ROC） curve,the cut-off value,sensitivity,specificity,and the area under the ROC curve（AUC） of NAGL,CysC and KIM-1at 6 h and 18 h for diagnosing AKI were obtained.The AUC of serum combination（NAGL,Cys C） and urine combination（NAGL,KIM-1） at 6 h and 18 h for diagnosing AKI was calculated.Results According to the diagnostic criteria of CRS1,48 of 200 ADHF patients were diagnosed with AKI and the incidence was 24%.Serum NAGL at 6 h and serum Cys C at 18 h positively correlated with Scr（r=0.857,P〈0.05;r=0.869,P〈0.05）.Urine NAGL and KIM 4 at 6 h positively correlated with Scr（r=0.756,P〈0.05;r=0.742,P〈0.05）.The AUCs of serum combination at 6 h and 18 h were 0.87 and 0.89,while the AUCs of urine combination at 6 h and 18 h were 0.92 and 0.93.Conclusion Serum and urine NAGL,serum Cys C,and urine KIM-1 can be used as early diagnostic indicators for CRSl patients.Combined detection of urine NAGL and KIM-1 may improve the sensitivity and specificity of early diagnosis of CRSl.

关 键 词：急性失代偿性心力衰竭 急性肾损伤 血清肌酐 中性粒细胞明胶酶相关脂质运载蛋白 胱蛋白酶抑制剂C 肾脏损伤分子1 

分 类 号：R541.6[医药卫生—心血管疾病]