体外循环二尖瓣置换术后急性肾损伤患者检测血清HMGB1和尿KIM-1的临床价值  

Changes and clinical significance of HMGB1, KIM-1 in acute kidney injury after cardiac surgeries with extracorporeal circulation

作　　者：葛熙 朱易华[1] 赵枰[1] 许一鸣[2] GE Xi;ZHU Yihua;ZHAO Ping;XU Yiming(Center of Clinical Laboratory Medicine,Second Affiliated Hospital of Nantong University,Jiangsu 226001;Department of Thoracic Surgery,the Second Affiliated Hospital of Nantong University, Jiangsu 226001)

机构地区：[1]南通大学第二附院医院检验科,江苏226001 [2]南通大学第二附院医院胸外科,江苏226001

出　　处：《交通医学》2019年第4期365-368,共4页Medical Journal of Communications

摘　　要：目的:探讨接受体外循环换瓣术患者检测血清高迁移率族蛋白Bl(high mobility group protein B1,HMGB1)和尿肾损伤分子-1(acute kidney injury,KIM-1)对早期诊断急性肾损伤(AKI)以及判断预后的价值。方法:接受体外循环换瓣术患者78例术后分为AKI组20例和非AKI组54例,分别留取术前及术后不同时间点的血液和尿液标本,检测血清肌酐(Scr)、HMGB1和尿KIM-1水平。结果:AKI组血清Scr在术后24 h升高显著,符合AKI诊断标准,48 h达到高峰值,不利于AKI早期诊断。AKI组术后6 h及以后时间点的尿KIM-1显著高于非AKI组,术后24 h及以后时间点血清HMGB1高于非AKI组,差异均有统计学意义(P<0.01)。AKI组术后6 h尿KIM-1与48 h血清Scr水平(r=0.743)、术后24 h血清HMGB1与7d血清Scr水平(r=0.815)均呈正相关(P<0.01)。AKI组ROC曲线下面积0.821,95%可信区间为0.812~0.863(P<0.01),临界点取1.97 ng/mL时敏感性及特异性分别为84.21%和75.14%。以术后24小时血清HMGB1判断预后,ROC曲线下面积为0.835,95%可信区间为0.837~0.899(P<0.01),临界点取4.08 ng/mL时敏感性及特异性分别为80.30%和89.12%。结论:体外循环下接受换瓣术的患者,检测尿KIM-1和血清HMGB1水平对早期诊断急性肾损伤和预后判断有重要指导价值。Objective:To investigate the relationship between HMGB1,KIM-1 and acute kidney injury(AKI) after mitral valve replacement,and to estimate their clinical significance. Methods: Based on the AKI diagnosis criterion,the study was conducted in 24 cases of AKI and 54 cases with no AKI undergoing cardiac surgery.Urine and serum samples were collected before and after operation , the serum Scr levels were detected by enzymatic method and HMGB1 and urinary KIM-1 was detected by ELISA.Results: Serum Scr levels increased significantly in patients with AKl within 24 hours after surgery,which met the AKI diagnostic criterion.Serum Scr levels reacheed a high peak at 48 hours, which is not conducive to early diagnosis of AKI. Compared with the cases without AKI, the levels of urinary KIM-1 at 6 hours after surgery and HMGB1 at 24 hours after surgery were significantly increased in patients with AKI(P<0.01). Furthermore, the level of urinary KIM-1, at 6 hours after surgery, Scr levels at 48 hours after surgery(r=0.738,P<0.01)and the level of HMGB1 at 24h after surgery were correlated-with Scr levels on 7 days positively(r=0.765,P<0.01). The ROC curve analyses showed that the urinary KIM-1 at 6 hours after surgery for AKI had the areas under the curves of 0.821, and 95%confidence interval was 0.812~0.863(P<0.01). When the designated cut-off points of urinary KIM-1 was≥207.94 μg/mmol, the sensitivities and specificities were 84.77% and 75.82%. The areas under the curves of HMGB1 on 24 h for prognosis was 0.835, and 95%confidence interval was 0.837~0.899(P<0.01). By using the designated cut-off points≥4.08 ng/mL, the sensitivities and specificities were 80.30% and 89.12%. Conclusion:Urinary KIM-1 and serum HMGB1 are useful markers for the early diagnosis and prognosis of AKI in mitral valve replacement patients with CPB.

关 键 词：体外循环 急性肾损伤 高迁移率族蛋白Bl 尿肾损伤分子-1 

分 类 号：R586[医药卫生—内分泌]