细胞间黏附因子-1、尿微量白蛋白、半乳糖凝集素-3在诊断体外循环下心脏瓣膜置换术后急性肾损伤发生中的作用  

Role of intercellular cell adhesion molecule-1,microscale albuminuria and galectin 3 expression in the development and diagnosis of acute kidney injury following cardiac valve replacement under cardiopulmonary bypass

作　　者：刘丹丹 王蕊 杨瑞霞 王珊珊 王苗苗 Liu Dandan;Wang Rui;Yang Ruixia;Wang Shanshan;Wang Miaomiao(Department of Cardiac Surgery,the 7th People′s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第七人民医院心外科,郑州450000

出　　处：《中国临床实用医学》2024年第5期16-21,共6页China Clinical Practical Medicine

摘　　要：目的探究细胞间黏附因子-1(ICAM-1)、尿微量白蛋白(MAU)、半乳糖凝集素-3(Gal-3)在体外循环下心脏瓣膜置换术后急性肾损伤(AKI)发生及诊断中的作用。方法本研究为单中心队列研究,选取2021年3月至2023年8月郑州市第七人民医院心外科收治的76例行体外循环下心脏瓣膜置换术患者,男40例,女36例,年龄(47.71±8.12)岁,年龄范围为37~62岁。根据术后48 h内是否发生AKI分为AKI组(n=25)和无AKI组(n=51)。比较两组患者的临床资料,多因素logistic回归分析体外循环下心脏瓣膜置换术后AKI的影响因素,分析ICAM-1、MAU、Gal-3对体外循环下心脏瓣膜置换术后发生AKI的诊断价值。结果AKI组术后ICAM-1[80.0%(20/25)]、Gal-3[88.0%(22/25)]和MAU[84.0%(21/25)]均高于无AKI组[19.6%(10/51)、21.6%(11/51)、17.6%(9/51)],差异有统计学意义(P<0.05)。多因素logistic回归分析显示,术后ICAM-1、Gal-3和MAU水平升高是患者进行体外循环下心脏瓣膜置换术后发生AKI的独立危险因素(P<0.05)。受试者操作特征曲线分析显示,ICAM-1、MAU和Gal-3的曲线下面积(AUC)分别为0.802、0.832和0.832时,约登指数最大,联合诊断AUC为0.901(95%CI:0.816~0.986)、灵敏度92.0%、特异度88.2%、阳性预测值79.3%、阴性预测诊断值95.7%,均高于各参数单项检验(P<0.05),诊断效能最佳。结论术后ICAM-1、Gal-3和MAU表达水平是患者进行体外循环下心脏瓣膜置换术后发生AKI的影响因素,ICAM-1、Gal-3和MAU的高表达会影响肾功能,可作为诊断体外循环下心脏瓣膜置换术后AKI的生物指标。ObjectiveTo explore the role of intercellular adhesion factor-1(ICAM-1),urinary microalbumin(MAU),galacttin-3(Gal-3)in the occurrence and diagnosis of acute kidney injury(AKI)after cardiac valve replacement under cardiopulmonary bypass.MethodsThis study was a single-center cohort study,which selected 76 patients from March 2021 to August 2023,including 40 males and 36 females,aged(47.71±8.12)years old,ranging from 37 to 62 years old.AKI group(n=25)and no AKI group(n=51)based on whether AKI occurred within 48 h after surgery.Comparing the clinical data of the two groups,multivariate logistic regression analyzed the factors affecting AKI after cardiac valve replacement under cardiopulmonary bypass,and analyzed the diagnostic value of ICAM-1,MAU and Gal-3 for AKI after cardiac valve replacement under cardiopulmonary bypass.ResultsPostoperative AKI group ICAM-1[80.0%(20/25)],Gal-3[88.0%(22/25)]and MAU[84.0%(21/25)]were higher than no AKI group[19.6%(10/51),21.6%(11/51),17.6%(9/51)],with statistically significant difference(P<0.05).Multivariate logistic regression analysis showed that increased postoperative ICAM-1,Gal-3 and MAU levels were independent risk factors for AKI after cardiac valve replacement surgery under cardiopulmonary bypass(P<0.05).Receiver operator characteristic curve analysis showed that the area under the curve(AUC)of ICAM-1,MAU and Gal-3 was 0.0802,0.832 and 0.832 respectively,and combined diagnostic AUC was 0.901(95%CI:0.816 to 0.986),sensitivity 92.0%,specificity 88.2%,positive predictive value 79.3%and negative predictive diagnostic value 95.7%,all higher than individual tests for each parameter(P<0.05),with the best diagnostic efficacy.ConclusionsICAM-1,Gal-3 and MAU expression levels are influencing factors of AKI after cardiac valve replacement under external circulation,and high expression of ICAM-1,Gal-3 and MAU can affect renal function and can be used as biological indicators of AKI after cardiac valve replacement under cardiopulmonary bypass.

关 键 词：细胞间黏附因子-1 尿微量白蛋白 半乳糖凝集素-3 心脏瓣膜置换术 急性肾损伤 

分 类 号：R654.2[医药卫生—外科学] R692[医药卫生—临床医学]