尿热休克蛋白-70在体外循环术后急性肾损伤早期诊断中的价值  

Value of urine HSP-70 in early diagnosis of acute kidney injury after cardiopulmonary bypass

作　　者：曹慧霞 任雪景 张丽娜 王利蒙 焦晓静 阎磊 杨雷一[3] 邵凤民 Cao Huixia;Ren Xuejing;Zhang Lina;Wang Limeng;Jiao Xiaojing;Yan Lei;Yang Leiyi;Shao Fengmin(Department of Nephrology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,People's Hospital of Henan University,Zhengzhou 450003,China;Henan Key Laboratory of Kidney Disease and Immunology,Zhengzhou 450003,China;Department of Cardiopulmonary Bypass,Henan Provincial People's Hospital,Department of Cardiopulmonary Bypass of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院肾内科郑州大学人民医院河南大学人民医院,郑州450003 [2]河南省肾脏病免疫重点实验室,郑州450003 [3]河南省人民医院体外循环科华中阜外医院体外循环科,郑州大学华中阜外医院,郑州450000

出　　处：《中华肾脏病杂志》2020年第4期294-299,共6页Chinese Journal of Nephrology

基　　金：国家重点研发计划(2018YFC1311202);河南省医学科技攻关计划(SBGJ2018062)。

摘　　要：目的评估尿热休克蛋白(HSP)-70在心脏体外循环心肺转流术(CPB)后急性肾损伤(AKI)早期诊断中的价值。方法选取2018年5月至2018年7月在河南省人民医院接受CPB治疗的患者为研究对象。收集入选者术前及术后0、2、4、6、8、12、24、48 h尿液标本和临床资料。按照肾脏病改善全球预后组织(KDIGO)AKI诊断标准分为AKI组和非AKI组。酶联免疫吸附法测定尿HSP-70、金属蛋白酶组织抑制因子2(TIMP-2)和胰岛素样生长因子结合蛋白7(IGFBP7)水平;免疫比浊法测定尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平。绘制受试者工作特征曲线(ROC),计算尿HSP-70、[TIMP-2]×[IGFBP7]、NGAL诊断CPB术后发生AKI的临界值、敏感度及特异度。结果共纳入45例患者,其中AKI组24例,非AKI组21例。AKI组术后各时间点尿HSP-70、[TIMP-2]×[IGFBP7]和NGAL水平显著高于非AKI组,组间比较差异有统计学意义(均P<0.05)。AKI组尿HSP-70在CPB术后2 h达到峰值,明显早于尿[TIMP-2]×[IGFBP7]、尿NGAL达峰值时间(分别为术后12 h和术后4 h)。术后2 h尿HSP-70≥2.1μg/L预测CPB术后AKI的曲线下面积(AUC)=1.00,灵敏度为100.0%,特异度100.0%;术后12 h尿[TIMP-2]×[IGFBP7]>19.1μg2/L2预测CPB术后AKI的AUC=0.94,灵敏度87.5%,特异度100.0%;术后4 h尿NGAL>27.4μg/L预测CPB术后AKI的AUC=0.95,灵敏度95.8%,特异度85.7%。术后2 h尿HSP-70≥2.1μg/L预测CPB术后AKI的阳性预测值为100.0%,阴性预测值100.0%。结论CPB术后AKI患者尿HSP-70水平升高早于尿[TIMP-2]×[IGFBP7]、NGAL,尿HSP-70水平监测有助于AKI的早期发现。Objective To assess the value of urine heat-shock protein-70(HSP-70)in the early diagnosis of acute kidney injury(AKI)after cardiac cardiopulmonary bypass(CPB).Methods Patients with cardiopulmonary bypass from May 2018 to July 2018 in Henan Provincial People's Hospital were enrolled as subjects.Urine samples were collected before and after cardiopulmonary bypass at 0 h,2 h,4 h,6 h,8 h,12 h,24 h and 48 h.Patients were divided into AKI group and non-AKI group according to the Kidney Disease:Improving Global Outcomes Guide.Urinary HSP-70,tissue inhibitor of metalloproteinase-2(TIMP-2)and insulin-like growth factor-binding protein 7(IGFBP7)were detected by enzyme-linked immunosorbent assay(ELISA)and urine neutrophil gelatinase-associated lipocalin(NGAL)was determined by immunoturbidimetry.The receiver operating characteristic(ROC)curve was plotted to calculate the critical value,sensitivity and specificity of urine HSP-70,[TIMP-2]×[IGFBP7]and NGAL for the diagnosis of postoperative AKI after CPB.Results A total of 45 patients were enrolled in the study.There were 24 cases in AKI group and 21 cases in non-AKI group.The level of urinary HSP-70,[TIMP-2]×[IGFBP7]and NGAL in AKI group were significantly higher than in the non-AKI group at each postoperative time point,with statistically significant differences(all P<0.05).The level of urinary HSP-70 in AKI group peaked at 2 h after CPB,which was significantly earlier than the peak time of urine[TIMP-2]×[IGFBP7]and urine NGAL(12 h after CBP and 4 h after CBP,respectively).Urinary HSP-70≥2.1μg/L could predict postoperative AKI of CPB at 2 h after CPB,with the area under the curve(AUC)of 1.00,the sensitivity of 100.0%and the specificity of 100.0%.Urinary[TIMP-2]×[IGFBP7]>19.1μg2/L2 could predict postoperative AKI of CPB at 12 h after CPB with the AUC of 0.94,the sensitivity of 87.5%,and the specificity of 100.0%.Urinary NGAL>27.4μg/L could predict postoperative AKI of CPB at 4 h after CPB with the AUC of 0.95,the sensitivity of 95.8%,and the specificity of 85.7%.The

关 键 词：急性肾损伤 心肺转流术 HSP70热休克蛋白质类 早期诊断 中性粒细胞明胶酶相关脂质运载蛋白 金属蛋白酶组织抑制因子2 胰岛素样生长因子结合蛋白7 

分 类 号：R65[医药卫生—外科学] R692[医药卫生—临床医学]