NGAL对成人心脏瓣膜置换术后急性肾损伤的早期诊断价值
发布时间：2018-04-08 14:32
本文选题：肾功能衰竭 切入点：急性 出处：《安徽医科大学》2014年硕士论文
【摘要】：目的探讨血、尿中性粒细胞明胶酶相关脂质运载蛋白(neutiophilgelatinase-associated lipocalin, NGAL)对成人心脏瓣膜置换术后急性肾损伤(acutekidney injury, AKI)的早期诊断价值。 方法前瞻性收集56例接受心脏瓣膜置换手术的成人患者术前及术后2、4、8、12及24h的静脉血液及尿液标本，分别测定血、尿NGAL及血肌酐(serum creatinine,Scr)，术后根据Scr水平将患者分为AKI组和非AKI组，用受试者工作特征（ROC）曲线评价血、尿NGAL对心脏瓣膜置换术后AKI的早期诊断价值。 结果 1.56例患者中有16例发生AKI，，发生率为28.57%。 2. AKI组Scr峰值出现在术后12～24h内。 3. AKI组术后2h血NGAL开始显著升高，4h时达峰值，与基础值(术前水平)比较差异有统计学意义（p0.05），术后尿NGAL较基础值上升（p0.05），并在2h时达高峰。AKI组血NGAL水平在术后8h及其以后各时间点保持较高水平，与基础值相比差异有统计学意义（p0.05），尿NGAL在术后4h及其以后各时间点均保持较高水平，但自术后12h起NGAL水平与基础值相比差异无统计学意义（p㧐0.05）。 4. AKI组术后4h血NGAL诊断AKI的ROC曲线下面积为0.891，95%的可信区间为0.809～0.920，以50μg/L作为AKI的诊断界限时表现出较高的敏感性及特异性；术后2h尿NGAL诊断AKI的ROC曲线下面积为0.934，95%的可信区间为0.871～0.998，以110μg/L作为诊断界限时表现出较高的敏感性及特异性。结论 .成人心脏瓣膜置换术后Scr诊断AKI较血、尿NGAL诊断滞后约20h，术后4h血液及术后2h尿液NGAL可作为AKI发生的早期诊断标志物。
[Abstract]:Objective to investigate the value of neutiophilia gelatinase-associated lipocalin (NGALs) in the early diagnosis of acute renal injury after cardiac valve replacement in adults.Methods the venous blood and urine samples were collected from 56 adult patients undergoing cardiac valve replacement before and after cardiac valve replacement. The blood, urine NGAL and creatinine creatinine creatinine were measured before and after operation. The patients were divided into AKI group and non-#en3# group according to the level of Scr after operation.The value of blood and urine NGAL in early diagnosis of AKI after cardiac valve replacement was evaluated by using the operating characteristics of subjects.Result1. AKI was found in 16 of 56 patients (28.57%).2.The peak value of Scr in AKI group appeared within 24 hours after operation.3.In AKI group, the serum NGAL increased significantly at 2 h after operation and reached the peak at 4 h after operation.Compared with the basic value (preoperative level), the difference was statistically significant (p0.05). The urine NGAL increased after operation compared with the basic value, and reached the peak at 2 h. The level of serum NGAL in the AKI group maintained a high level at 8 hours after the operation and at every time point after the operation.Compared with the basic value, the difference was statistically significant (p 0.05), and the level of urinary NGAL remained high at 4 h after operation and at every time point after operation, but there was no significant difference between the level of NGAL and the basic value since 12 h after operation.4.In the AKI group, the area under the ROC curve was 0.891V 95% and the confidence interval under the ROC curve was 0.809 卤0.920. The sensitivity and specificity of 50 渭 g / L as the diagnostic limit for AKI were higher than those in the control group.2 hours after operation, the area under the ROC curve of urine NGAL was 0.934 卤95%. The confidence interval of 0.871g / L was 0.998.The sensitivity and specificity were higher when 110 渭 g / L was used as the diagnostic limit.Conclusion.The diagnosis of AKI by Scr after cardiac valve replacement in adults was more than that by blood, and the diagnosis of NGAL in urine was delayed by about 20 hours. NGAL in blood 4 hours after operation and in urine at 2 hours after operation could be used as an early diagnostic marker for the occurrence of AKI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R692
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