肾损伤分子-1对梗阻性肾病围手术期肾功能改变的评估意义  

作　　者：郭利 艾晓林[3] 许倩[3] 迟强[2] 李红阳[2] 王志勇[2] 

机构地区：[1]河北省承德市妇幼保健院,067000 [2]承德医学院附属医院,河北067000 [3]承德医学院,河北067000

出　　处：《浙江临床医学》2018年第3期493-495,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨肾损伤分子-1（KIM—1）对单侧梗阻性肾病患者围手术期肾功能变化的评估意义。方法以^99mTc—DTPA核素肾动态显像测定肾小球滤过率（GFR）作为肾功能评价标准，依据患肾GFR将患者分为：肾功能正常组、轻度损伤组、中度损伤组、重度损伤组，并以体检健康者作为尿KIM-1的正常对照组，通过ELISA法检测术前及术后第1、2、3、7天尿KIM-1的表达水平，同时检测血肌酐（Scr）、尿素氯（BUN）水平，术后第7天时复查GFR。结果术前各组尿KIM-1的表达高于健康对照组（P〈0．05），肾功能正常组与轻度损伤组的比较及正常组、轻度损伤组与中度、重度损伤组比较差异均有统计学意义（P〈0．05），但中度与重度损伤组间比较差异无统计学意义（P〉0．05），各组术前、术后不同时间比较差异无统计学意义（P〉0．05）。通过ROC曲线分析显示：术前尿KIM-1的曲线下面积为0．804，95％可信区间0．664-0944，敏感度0826，特异度0．667，较Scr、BUN更具敏感性（P〈0．01）。术前及术后第7天尿KIM-1、Scr、BUN与患肾GFR相关性分析显示：尿KIM-1，可作为术后早期肾功能变化监测与患肾GFR呈负相关（P〈0．05），Scr、BUN与患肾GFR无明显相关。结论尿KIM-1有助于单侧梗阻性肾病肾功能损伤的诊断的稳定指标。Objective To investigate the significance of kidney injury molecule-1 KIM-1 in the evaluation of renal function in patients with unilateral obstructive nephropathy during perioperative period. Methods The glomerular filtration rate （ GFR ） was measured by 99mTe-DTPA radionuclide renal dynamic imaging. The patients were divided into four groups： normal renal function group, mild injury group, moderate injury groups, severe injury group and healthy subjects as urine KIM-1 normal control group. The level of KIM-1 expression was measured by ELISA before and 1, 2, 3 and 7 days after operation, simultaneous detection of serum creatinine （Scr） , urea nitrogen （ BUN ） levels, 7 days after the review of GFR. Results The expression of urinary KIM-1 in the preoperative group was higher than that in the healthy control group （P〈0.05） , the comparison between the normal group and the mild group （ P〈0.05 ） , but there was no significant difference between the moderate and severe injury groups （ P〉0.05 ） . There was no significant difference between the two groups before and after operation （ P〉0.05 ） . The area under the curve of KIM- 1 was 0.804, the confidence interval was 0.664-0.944, the sensitivity was 0.826, the specificity was 0.667, which was more sensitive than Scr and BUN （ P〈0.01 ） . The correlation between urinary KIM-1, Scr, BUN and renal GFR showed that urine KIM-1 was negatively correlated with GFR （ P〈0.05 ） , Scr, BUN and kidney obviously relevant. Conclusion Urine KIM-1 helps the diagnosis of renal dysfunction in unilateral obstructive nephropathy, and can be used as a stable indicator of early renal function changes.

关 键 词：肾损伤分子-1 梗阻性肾病 肾功能评估 

分 类 号：R743.3[医药卫生—神经病学与精神病学]