心脏手术后早期急性肾损伤中尿NGAL与尿Cystatin C的表达及意义  

After heart surgery early acute renal injury in urine NGAL and urine Cyst C of clinical comparison and significance

作　　者：刘红[1] 岳华[1] 刘颖[1] 

机构地区：[1]新疆维吾尔自治区人民医院肾脏病研究室,新疆乌鲁木齐830001

出　　处：《国际泌尿系统杂志》2015年第5期743-747,共5页International Journal of Urology and Nephrology

基　　金：新疆维吾尔自治区人民医院课题资助（编号：20100118）

摘　　要：目的 探讨尿中性粒细胞明胶酶相关载脂蛋白（neutrophil gelatinase-associated lipocalin,NGAL）、尿胱蛋白酶抑制剂C（Cystatin C,Cyst C）对心脏手术后急性肾损伤（AKI）早期诊断的敏感性及临床意义.方法 资料来源为本院心脏外科行心脏手术的住院患者105例,并收集手术前、手术后24h、48h、72h的血尿标本,分别测定尿NGAL、Cyst C及血Scr的水平,根据AKI诊断标准定义（血Scr较基础值增加≥50％）为分组标准,选取其中65例为AKI组,其余40例为非AKI组并观察两组各项指标的变化情况.尿NGAL、Cyst C测定均采用酶联免疫法（ELISA）检测,血Scr采用比浊法检测.并以受试者工作特征（ROC）曲线及曲线下面积（AUC）评价各项指标对诊断AKI的敏感性.结果 两组患者术前血Sct、NGAL及CystC比较差异均无统计学意义（P＞0.05）,AKI组的各项指标分别在术后的不同时间点较非AKI组显著升高,比血Scr升高时间提前24h,术后各时间点比较差异存在统计学意义（P＜0.001）.尿Cyst C、NGAL术后24h、48h升高明显,而术后72h开始下降,各时间点比较差异均有统计学意义（P＜0.001）,术后各时间点尿CystC的敏感性好于NGAL,联合两种尿液指标的最佳诊断时间点48h,得到的AUC为0.802（0.759～0.858）.结论 联合2项尿液指标可以作为成人心脏手术后AKI的早期诊断指标,可以提高AKI早期诊断的准确率,对预防急性肾损伤的发生、发展具有重要的诊断价值及临床意义。Objectives To explore the sensitivity of clinical significance of urine neutrophils gelatin enzyme related apolipoprotein （neutrophil Gelatinase-associated lipocalin,NGAL） and urinary bladder Cystatin C （protease inhibitorsC,Cyst C） in early diagnosis for heart surgery acute kidney injury（AKI）.Methods To analyse 105 cases who had underwent cardiac surgery in our hospital.24h,48h,72h blood and urine specimens were collected before and after the operation,urine NGAL,Cyst C and serum Ser were detected respectively.All cases were divided into AKI group（65cases） and non AKI group （40cases） based on the AKI diagnosis criteria （Scr based frequency value increases 50%）,Each index had been compared.urine NGAL and Cyst C were respectively detected by enzyme linked Immuno sorbent assay（ELISA）,the serum Scr were detected by turbidity method.The receiver-operating characteristic（ROC） curve and the area under the curve（AUC） were used to assess the sensitivity.Results The Scr,NGAL and CystC in two groups were not significant differences（P 〉 0.05）,The biological markers of AKI in different time points were significantly increased in AKI group than in non AKI group.The differences in different time points after surgey were statistically significant（P 〈0.001）.Urine CystC,NGAL in postoperative 24h,48h rise obviously,but in postoperative 72 h began to decline,and differences at each time point were statistically significant（P 〈 0.001）,The sensitivity of the postoperative urine Cyst at each time point is better than that of NGAL,the best diagnosis time point was 48h after operation,which can get AUC for 0.802 （0.759 ～ 0.858）.Conclusions NGAL combined Cystatin C can be used as early diagnosis indexs of AKI.It is valuable that they can improve the accuracy of early diagnosis and prevent acute renal damage.

关 键 词：肾疾病 心脏外科手术 载脂蛋白类 

分 类 号：R692[医药卫生—泌尿科学]