成人心脏体外循环术后急性肾损伤与中性粒细胞明胶酶相关性脂质运载蛋白表达相关性研究

发布时间：2018-01-12 14:39

本文关键词：成人心脏体外循环术后急性肾损伤与中性粒细胞明胶酶相关性脂质运载蛋白表达相关性研究　出处：《中国实用内科杂志》2016年06期 　论文类型：期刊论文

【摘要】：目的探讨中性粒细胞明胶酶相关性脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)在心脏体外循环术(cardiopulmonary bypass,CPB)后急性肾损伤(AKI)早期诊断中的价值,为CPB-AKI患者的早期诊断和预防提供简便、可靠的循证医学证据。方法选取2010年12月至2011年5月入住上海长海医院心胸外科接受择期体外循环手术的住院患者64例,其中男32例,女32例;年龄平均(53.8±12.0)岁。按KDIGO指南诊断标准,分为非AKI组及AKI组,采集患者术前及术后各时间点的静脉血及尿液标本,酶法测定血清肌酐,ELISA方法检测尿NGAL(uNGAL)表达,运用受试者工作特征曲线(receiver operator characteristic,ROC)及曲线下面积(area under the curve,AUC)评估尿NGAL表达水平与肾损伤程度之间的关系。结果 64例体外循环手术后患者10例发生AKI(15.6%);与非AKI组相比,AKI组术后2 h起uNGAL表达明显升高,Cut off值在296μg/L时,其诊断AKI的敏感度和特异度分别为90.0%和79.6%;术后2 h的uNGAL与术后24 h血肌酐(Scr)呈正相关。结论 CPB-AKI患者uNGAL表达水平较非AKI组明显增加,其增加程度与AKI严重程度呈正相关,uNGAL可作为CPB-AKI患者早期诊断的敏感指标。
[Abstract]:Objective to investigate the expression of neutrophil gelatinase associatedlipocalin (neutrophil gelatinase-associated, lipocalin, NGAL) in cardiopulmonary bypass (cardiopulmonary bypass, CPB) after acute kidney injury (AKI) in the early diagnosis value for early diagnosis and prevention of CPB-AKI patients to provide a simple, reliable evidence based medicine methods from December 2010 to May 2011. Department of cardiothoracic surgery at Changhai Hospital of Shanghai underwent surgery undergoing cardiopulmonary bypass in 64 cases, male 32 cases, female 32 cases; the average age (53.8 + 12) years old. According to the standard guidelines for the diagnosis of KDIGO, divided into non AKI group and AKI group. The blood and urine samples were collected before and after the operation at each time point determination of serum creatinine, enzyme method, ELISA method for detection of urinary NGAL (uNGAL) expression, using the receiver operating characteristic curve (receiver operator characteristic ROC (area) and area under curve UN Der the curve, AUC) to evaluate the relationship between urinary NGAL expression and renal damage. Results 64 cases of off-pump surgery occurred in 10 cases of AKI (15.6%); compared with the non AKI group, AKI group after 2 h significantly increased the expression of uNGAL, Cut and off values at 296 g/L, its diagnosis the sensitivity and specificity of AKI were 90% and 79.6%; after uNGAL operation and 2 h after 24 h serum creatinine (Scr) were positively correlated with CPB-AKI. Conclusion the expression level of uNGAL compared with non AKI group increased significantly, the increase was positively correlated with the severity of the AKI, uNGAL may be a sensitive index of early diagnosis of CPB-AKI patients broken.

【作者单位】：武警江苏总队医院肾内科;第二军医大学附属长海医院心胸外科;解放军肾脏病研究所第二军医大学附属长征医院肾内科;
【基金】：国家十二五支撑计划(2011BAI10B07)
【分类号】：R692;R654.2
【正文快照】： 心脏体外循环术(cardiopulmonary bypass,CPB)后急性肾损伤(acute kidney injury,AKI)发生率可高达30%~55%,是显著增加患者死亡风险的独立危险因素之一[1]。早期诊断、及时干预可有效改善其预后。中性粒细胞明胶酶相关性脂质运载蛋白(neutrophil gelatinase-associated lipoca

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