尿中性粒细胞明胶酶相关脂质运载蛋白对小儿先心病术后发生急性肾损伤的预测价值

Urinary neutrophil gelatinase-associated lipocalin in predicting acute kidney injury after congenital heart surgery

目的:探讨尿NGAL对于早期预测小儿先心病术后发生AKI的价值。方法:选取2017年1月~2017年12月在我院心外科行先心病手术的患儿120例,根据AKI的诊断标准分为AKI组(n=32例)和非AKI组(n=88例),检测两组术前血肌酐、尿NAGL、血CysC及术后6、12、24、48小时尿NAGL及血CysC水平,探讨尿NGAL对于预测小儿先心病术后发生AKI的价值。结果:术后6、12、24、48小时AKI组尿NAGL水平较非AKI组明显升高,差异有统计学意义,AKI组尿NGAL水平在术后12小时达高峰;血CysC术后6小时AKI组与非AKI组相比无统计学差异,术后12、24、48小时AKI组血CysC水平较非AKI组明显升高,差异有统计学意义,AKI组血CysC水平在术后24小时达高峰。尿NAGL诊断AKI的最佳时间点为术后12h,AUC为0.883(95%CI 0.793~0.902);血CysC诊断AKI的最佳时间点为术后24h,AUC为0.811(95%CI 0.765~0.828)。结论:与血CysC相比,尿NAGL对于小儿先心病术后发生急性肾损伤有更好的早期预测价值。

Objective To test the predicative roles of urinary neutrophil gelatinase-associated lipocalin(NGAL)in acute kidney injury after congenital heart surgery.Methods One hundred-twenty patients with congenital heart surgery in our hospital from January 2017 to December 2017 were selected,which were divided into AKI(n=32)and non-AKI group(n=88)according to urine creatinine levels.Then the levels of serum creatinine,urinary NGAL and serum cystatin C were detected before surgery and 6,12,24,48 hours after surgery.Their diagnostic value for acute kidney injure was analyzed.Results The level of NGAL were significantly increased in 6,12,24,48 hours after surgery.The level of NGAL of AKI groups reached the peak at 12 h after surgery.The level of CysC showed no significant changes between the two groups at 6 h after surgery.The level of CysC were significantly increased in 12,24,48 hours after surgery.The level of CysC of AKI groups reached the peak at 24 h after surgery.The best time of NGAL in detection of AKI was at 12 h after surgery and AUC was 0.883(95%CI 0.793~0.902).The best time of Cys C in detection of AKI was at 24 h after surgery and AUC was 0.811(95%CI 0.765~0.828).Conclusion The urinary NGAL is more sensitive than CysC in predict the acute kidney injury after congenital heart surgery.