多中心研究尿液Netrin-1在早期诊断造影剂所致急性肾损伤中的价值  

Value of urinary Netrin-1 as an early biomarker for contrast-induced acute kidney injury after coronary angiography:a multicenter study

作　　者：沈剑箫[1] 王玲[1] 张翩[1] 何奔[2] 沈玲红[2] 王肖龙[3] 邱建平[4] 郑昌柱[5] 杨光敏[6] 孙静[3] 林捷[4] 倪兆慧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科,上海2000127 [2]上海交通大学医学院附属仁济医院心内科,上海2000127 [3]上海中医药大学附属曙光医院 [4]上海市浦东新区公利医院 [5]上海市第七人民医院心内科 [6]上海市浦东新区浦南医院心内科

出　　处：《上海医学》2015年第5期354-359,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(81370794;81373865);上海市科学技术委员会基础研究重大项目(12DJ140020);浦东新区科技发展基金创新资金(PKJ2009-Y12)资助项目

摘　　要：目的 观察造影剂所致急性肾损伤（CI-AKI）进程中患者尿液Netrin-1水平的变化,探讨其对CI-AKI早期诊断的价值。方法 多中心前瞻性收集197例行冠状动脉造影术（CAG）患者的临床资料,其中发生急性肾损伤（AKI）患者17例（CI-AKI组）,另选取17例与CI-AKI患者临床资料匹配的非CI-AKI患者（非CI-AKI组）,检测两组患者在CAG前后多个时间点的尿液Netrin-1、尿液N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、血清肌酐（sCr）、血清半胱氨酸蛋白酶抑制剂C（CysC）水平,评价尿液Netrin-1作为CI-AKI早期诊断标志物的价值。结果 CI-AKI组患者除CAG持续时间显著长于非CI-AKI组（P〈0.05）外,两组间患者的一般资料、基础疾病构成、基础肾功能、实验室检查结果、术前用药情况,以及其他CAG和经皮冠状动脉介入治疗（PCI）情况的差异均无统计学意义（P值均〉0.05）。CI-AKI组在CAG后2、6、12h的尿液Netrin-1水平均显著高于同组基础值（P值均〈0.05）,非CI-AKI组仅在CAG后6h时的尿液Netrin-1水平显著高于同组基础值（P〈0.05）。CAG后2h,CI-AKI组的尿液Netrin-1水平显著高于非CI-AKI组同时间点（P〈0.05）,此时尿液Netrin-1水平诊断CI-AKI的ROC曲线的AUC为0.706（95%CI为0.531~0.880,P=0.040）。CI-AKI组在CAG后48、72h的sCr水平,在CAG后2、6h的尿液NAG水平均显著高于同组基础值（P值分别〈0.01、0.05）;非CI-AKI组在CAG后2、6、12、24h的尿液NAG水平均显著高于同组基础值（P值分别〈0.01、0.05）。CI-AKI组在CAG后72h的血清CysC水平显著高于非CI-AKI组同时间点（P〈0.05）。结论尿液Netrin-1水平对早期诊断CI-AKI有一定价值,sCr、尿液NAG、血清CysC水平并不适用于CI-AKI的早期诊断。Objective To determine the value of urinary Netrin-1 as a biomarker for early detection of contrast-induced acute kidney injury （CI-AKI）. Methods Clinical data of 197 patients from five centers undergoing coronary angiography with contrast medium exposure were prospectively enrolled in this study. CI-AKI was diagnosed in 17 patients （CI-AKI group）, another 17 patients without CI-AKI matched with the CI-AKI subjects were selected for control group （non-CI-AKI group）. Urine and serum samples were obtained at different time points before and after coronary angiography （CAG）. Urinary Netrin-1, urinary N-acetyi-②-D-glucosaminidase （NAG）, serum cretinine （sCr） and cystatin C （CysC） were measured. Results There were no significant differences in terms of general data, primary diseases, renal function, experimental examination, preoperative medication, or percutaneous coronary intervention （POD between two groups （all P〉0.05）. But the duration of CAG in CI-AKI group was significantly longer than that in non-OI-AKI group （ P 〈 0. 05）. Compared with the baseline, Netrin-1 leveLs at 2h, 6h and 12 h after CAG in CI-AKI group and only at 6 h after CAG in non-CI-AK1 group were significantly increased （P〈0.05, 0.01）. Netrin-1 level in CI-AKI group was significantly higher than that in non-CI-AKI group at 2 h after CAG （P〈0.05）. For urinary Netrin-1, area under the receiver-operating characteristics curve （AUC） was 0. 706 （95% OI ： 0. 531 - 0. 880, P = 0. 040） at 2 h after CAG. Compared with the baseline, sOr levels at 48 h and 72 h after CAG in CI-AKI group and NAG levels at 2 h and 6 h after CAG in 01- AKI group and at 2 h, 6 h, 12 h and 24 h after CAG in non-CI-AKI group were significantly increased （P〈0.05, 0.01）. Serum CysC level in CI-AKI group was significantly higher than that in non-CI-AKI group at 72 h after CAG （P〈0.05）. Conclusion Urinary Netrin-1 is superior to NAG, serum creatinine and Cystatin C for the early diagnosis of CI-AKI.

关 键 词：尿液Netrin-1 造影剂所致急性肾损伤 生物标志物 早期诊断 

分 类 号：R692[医药卫生—泌尿科学]