尿NGAL和KIM-1对儿童体外循环心脏术后AKI的诊断意义  

Diagnostic significance of urinary neutrophil gelatin enzyme-related lipid delivery protein and kidney injury molecule-1 in acute kidney injury after cardiac operation with cardiopulmonary bypass operation in children

作　　者：温昱鹏[1] 李宗虓 常诚 张鹏[2] 吕扬 

机构地区：[1]天津医科大学儿童临床学院天津市儿童医院心脏外科,300134 [2]天津医科大学总医院心胸外科,300052 [3]天津医科大学肿瘤医院重症监护科,300040

出　　处：《中华危重病急救医学》2017年第12期1112-1116,共5页Chinese Critical Care Medicine

基　　金：天津市卫生局科技基金（2014KY16）

摘　　要：目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤分子-1（KIM-1）对非紫绀型先天性心脏病（先心病）患儿体外循环（CPB）术后急性肾损伤（AKI）的诊断价值。方法回顾性分析2015年6月至2017年5月天津市儿童医院收治的200例在CPB下行心脏手术的非紫绀型先心病患儿的临床资料，将术后48 h内发生AKI的患儿纳入AKI组，同时选取其中与AKI患儿性别、年龄、体重、基础合并症、手术时间等因素相匹配的非AKI患儿纳入非AKI组。比较两组患者术前及术后各时间点血肌酐（SCr）和尿NGAL、KIM-1〔以尿肌酐（UCr）校正〕的差异，用受试者工作特征曲线（ROC）分析其对术后AKI的诊断价值。结果CPR术后48 h内有32例患儿发生不同程度的AKI，发生率为16.0%；非AKI对照组60例。与非AKI组比较，AKI组术后2 h尿NGAL、术后4 h尿KIM-1、术后10 h SCr即显著升高，分别于6、8、24 h达高峰后逐渐下降。诊断AKI的ROC曲线下面积（AUC）和95%可信区间（95%CI）分别为术后2 h尿NGAL 0.940（95%CI=0.890-0.990）、术后4 h尿KIM-1 0.939（95%CI=0.891-0.986）、术后10 h SCr 0.959（95%CI=0.916-1.000）。术后2 h尿NGAL截断值为588.0 μg/g时，诊断AKI的敏感度为87.5%，特异度为95.0%，准确性为93.5%；术后4 h尿KIM-1截断值为9.55 ng/mg时诊断AKI的敏感度为87.5%，特异度为91.7%，准确性为90.2%；术后10 h SCr截断值为61.90 μmol/L时诊断AKI的敏感度为90.6%，特异度为95.0%，准确性为95.7%。结论尿NGAL和KIM-1可以作为早期诊断非紫绀型先心病患儿CPB术后AKI的生物学标志物。ObjectiveTo investigate the diagnostic value of urinary neutrophil gelatin enzyme-related lipid delivery protein （NGAL） and kidney injury molecule-1 （KIM-1） in the acute kidney injury （AKI） after cardiopulmonary bypass （CPB） operation in children with non-cyanotic congenital heart disease （CHD）.MethodsA retrospective analysis was conducted. 200 CPB undergoing cardiac surgery in children with non-cyanotic CHD admitted to Tianjin Children＇s Hospital from June 2015 to May 2017 were enrolled. All patients were divided into AKI group and non-AKI group within 48 hours after operation, and the two groups matched with age, sex, weight, basic complications, operation time and other factors. The differences in serum creatinine （SCr）, urinary NGAL and KIM-1 [corrected for urinary creatinine （UCr）] between the two groups before and after operation were compared. The early diagnosis value of urinary NGAL and KIM-1 on AKI was analyzed by the receiver operating characteristic curve （ROC）.ResultsThere were 32 patients with different degrees of AKI 48 hours post operation, and the incidence was 16.0%; 60 cases were enrolled in non-AKI group. Compared with non-AKI group, urinary NGAL at 2 hours after operation, urine KIM-1 at 4 hours after operation, and SCr at 10 hours after operation in AKI group were significantly increased, which decreased gradually after reaching peak at 6, 8, 24 hours respectively. It was shown by ROC curve analysis that the area under ROC curve （AUC） and 95% confidence interval （95%CI） of postoperative 2-hour urine NGAL, 4-hour urine KIM-1 and 10-hour SCr for diagnosis of AKI were 0.940 （95%CI = 0.890-0.990）, 0.939 （95%CI = 0.891-0.986） and 0.959 （95%CI = 0.916-1.000） respectively. When the cut-off value of postoperative 2-hour urine NGAL was 588.0 μg/g, the sensitivity was 87.5%, the specificity was 95.0%, the accuracy was 93.5%; when the cut-off value of postoperative 4-hour urine KIM-1 was 9.55 ng/mg, the sensitivity was 87.5%, the specificity was 91

关 键 词：先天性心脏病 体外循环 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 肾损 伤分子-1 诊断 生物标志物 

分 类 号：R726.5[医药卫生—儿科] R726.9[医药卫生—临床医学]