心脏手术后并发急性肾损伤早期诊断指标的研究  

Value of indices in early diagnosis of cardiac surgery associated acute kidney injury

作　　者：金科[1] 王秋卉[1] 董亮[1] 严洁[1] 

机构地区：[1]无锡市人民医院重症医学科,江苏无锡214023

出　　处：《中国急救医学》2017年第9期808-811,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨尿液指标对心脏手术后患者并发急性肾损伤（AKI）的早期诊断价值。方法 根据前瞻性研究设计记录心脏手术后患者的一般情况，并分别在术前和术后1、6、24 h检测尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL），计算出尿钠排泄分数（FENa）、尿素排泄分数（FEU）。根据患者病情演变，分为AKI组和非AKI组，将观察指标的变化进行分析。 结果 共纳入76例心脏手术后患者，21例发生AKI，发生率27.6%。AKI组患者年龄、男性比例、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、主动脉阻断时间、ICU住院时间均高于非AKI组，AKI组患者术后6 h尿量少于非AKI组（P〈0.05）。AKI组尿NGAL水平在术后24 h显著高于非AKI组；AKI组在术后1、6、24 h FENa均高于非AKI组；AKI组在术后6 h FEU低于非AKI组（P〈0.05）。术后24 h尿NGAL的ROC曲线下面积为1.000，诊断点为36.9 ng/mL，敏感度和特异度均为1.000；术后1 h FENa指标的ROC曲线下面积为0.897，最佳诊断值为1.8，敏感度为 0.851，特异度为0.782；术后6 h FEU的ROC曲线下面积为0.997，最佳诊断值为26.5，敏感度为 0.952，特异度为1.000。结论 术后6 h FEU和24 h 尿NGAL超出诊断值对心脏手术后并发AKI具有早期评估价值，6 h FEU可作为AKI早期诊断指标。Objective To evaluate the diagnostic value of urinary indices of cardiac surgery associated acute kidney injury （AKI） at early stage. Methods We performed a prospective study on patients undergoing cardiac surgery. The urine neutrophil gelatinase - associated lipocalin （NGAL）, fractional excretion of sodium （FENa）, fractional excretion of urea （FEU） measured at before surgery and 1, 6, 24 h following surgery. According to the incidence of AKI, the patients were divided into AKI group and no AKI group. The changes of those urinary indices were analyzed. Results 76 patients were enrolled; 21 （27.6%） patients after cardiac surgery developed AKI. Age, male rate, APACHEⅡ score, aortic cross -clamp time and length of ICU stay in AKI group were significantly higher than in no AKI group （P 〈 0.05 ）. Urine NGAL in patients with AKI was significantly higher compared with that in patients without AKI 24 h after cardiac surgery （P 〈0.05 ）. FENa was statistically significant 1,6, 24 h after cardiac surgery between two groups （ P 〈 0.05 ） ; arid it was also statistically significant 6 h after cardiac surgery between two groups （ P 〈 0.05）. 24 h after cardiac surgery, the AUC of urinary NGAL was 1. 000 ; the sensitivity was 1.0 and specificity was 1.0 with a cutoff value of 36.9 ng/mL. The AUC of FENa was 0. 897 ; the sensitivity was 0. 851 and specificity was 0.782 with a cutoff value of 1.8, at the time point of 1 h after cardiac surgery. FEU showed a 0.952 sensitivity and 1. 000 specificity with a cutoff value of 26.5 ; the AUC was 0.997 6 h after cardiac surgery. Conclusion 6 h FEU, 24 h urine NGAL after cardiac surgery are predictive of AKI. 6 h FEU is useful as an early diagnosis indicator.

关 键 词：急性.肾损伤(AKI) 尿素排泄分数(FEU) 尿钠排泄分数(FENa) 中性粒细胞明胶酶相关脂质运载蛋白(NGAL) 

分 类 号：R135.1[医药卫生—劳动卫生]