尿中性粒细胞明胶相关性载脂蛋白和肾损伤分子1水平监测在预测对比剂肾病中的意义  

The significances of monitoring urine NGAL and KIM -1 levels before and after coronary intervention in ;early predication of contrast-induced nephropathy

作　　者：李朋[1] 李睿[1] 胡威[1] 徐建辉[1] 徐业成[1] 易日霞 王丹丹[1] 杨海珍[1] 

机构地区：[1]孝感市中心医院心内科,湖北省孝感432000

出　　处：《中国基层医药》2015年第21期3266-3270,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：探讨冠脉介入前后尿中性粒细胞明胶相关性载脂蛋白（NGAL）和肾损伤分子1（KIM-1）水平监测在早期预测对比剂肾病中的意义。方法收集249例行冠脉介入治疗的冠心病患者的临床资料，根据术后是否发生对比剂肾病分为对比剂肾病组（n ＝21）和非对比剂肾病组（n ＝228），于术前及术后4 h、12 h、24 h、48 h、72 h 检测血清肌酐，于术前和术后4 h、12 h、24 h、48 h，采用 ELISA 对患者尿中 NGAL 和 KIM-1水平进行检测，分析 NGAL、KIM-1预测对比剂肾病的灵敏度、特异度。结果与术前比较，对比剂肾病组术后48 h 血清肌酐水平[（101．7±20．3）μmol／L]升高，差异有统计学意义（t ＝15．972，P ＜0．05）。与术前比较，对比剂肾病组术后4 h、12 h、24 h、48 h 尿 NGAL 水平分别为（12．3±1．6）μg／L、（14．5±1．5）μg／L、（14．1±1．2）μg／L、（14．3±1．4）μg／L，均升高（t ＝8．672、11．817、15．942和17．641，均 P ＜0．05）；术后24 h、48 h 尿 KIM-1水平分别为（5．1±0．9）μg／L、（5．5±1．3）μg／L，均升高（t ＝9．672和14．381，均 P ＜0．05）。对比剂肾病组术后4 h、12 h、24 h、48 h 尿 NGAL 水平均高于非对比剂肾病组，术后24 h、48 h 尿 KIM-1水平均高于非对比剂肾病组，差异均有统计学意义（t ＝17．838、19．370、13．996、18．172、2．792、3．307，均 P ＜0．05）。Pearson 相关分析显示，对比剂肾病组术后4 h 尿 NGAL 水平和24 h 尿 KIM-1水平均与术后48 h 血清肌酐水平呈正相关（r ＝0.698、0.576，均 P ＜0．05）。ROC 曲线分析显示，尿 NGAL 水平预测对比剂肾病曲线下面积0．963（95％CI：0.931～0．995），灵敏度85．7％，特异度94．3％；尿 KIM-1水平预测对比剂肾病曲线下面积0．839（95％CI：0.768～0.909），灵敏度81．0％，特异度72．8％。结论行介入治疗后发生对比剂肾病患者于�Objective To investigate the significances of monitoring urine neutrophil gelatinase -associated apolipoprotein （NGAL）and kidney injury molecule -1 （KIM-1）levels before and after coronary intervention in early predication of contrast -induced nephropathy.Methods The clinical data of 249 patients with coronary heart disease undergoing percutaneous coronary intervention were collected.All patients were divided into contrast -induced nephropathy group（n =21 ）and non -contrast -induced nephropathy group（n =228）according to whether had contrast -induced nephropathy.Before surgery and 4h,12h,24h,48h,72h after surgery,the levels of serum creatinine were tested.Before surgery and 4h,12h,24h,48h after surgery,the levels of urinary NGAL and KIM-1 were detected by using enzyme -linked immunosorbent assay（ELISA）.Results Compared with before surgery,the serum creati-nine level of contrast -induced nephropathy patients after surgery 48h[（101.7 ±20.3）μmol/L]was elevated,the difference was statistically significant（t =15.972,P 〈0.05）.Compared with before surgery,the urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were （12.3 ±1.6）μg/L,（14.5 ±1.5 ）μg/L, （14.1 ±1.2）μg/L and （14.3 ±1.4）μg/L,which were significantly elevated（t =8.672,11.817,15.942 and 17.641,all P 〈0.05）,and the urinary KIM-1 levels after surgery 24h and 48h were （5.1 ±0.9）μg/L and （5.5 ± 1.3）μg/L,which were elevated,the differences were statistically significant（t =9.672,14.381,all P 〈0.05）.The urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were higher than non -contrast-induced nephropathy patients,and the urinary KIM-1 levels after surgery 24h and 48h were higher than non -contrast -induced nephropathy patients,the differences were statistically significant（t =17.838,19.370,13.996, 18.172,2.792,3.307,all P 〈0.05）.Pearson correlation analysis showed that the urinary NGAL levels after 4h and urinary KIM-1 leve

关 键 词：冠状动脉介入术 经皮 对比剂肾病 中性粒细胞明胶相关性载脂蛋白 肾损伤分子 1 Kidney injury molecule -1 

分 类 号：R692[医药卫生—泌尿科学]