尿NGAL、KIM-1及Cys C在体外循环术后急性肾损伤早期诊断中的意义

Urinary NGAL, KIM-1 and Cys C in diagnosis of acute kidney injury after cardiopulmonary bypass

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肾损伤分子-1（KIM-1）及胱蛋白酶抑制剂C（CysC）在体外循环术后急性肾损伤（acute kidney injury，AKI）早期诊断中的价值与意义。方法选择267例进行体外循环手术的心脏病患者，体外循环结束后第一个12h内每2h采集尿样及血样1次，此后3d内每12h采集1次，对尿中NGAL、KIM-1及CysC进行定量分析，同时在相应时间点检测血清肌酐水平，血清肌酐比基线水平增加50％以上为发生AKI的标准。结果术后3d内有54例发生不同程度AKI，术后2h的尿NAGL、KIM—1及CysC的ROC曲线下面积分别为0．89、0．84和0．67，联合检测尿NAGL和KIM-1，ROC曲线下面积为0．96，可以提高AKI早期诊断的敏感性和特异性。结论尿NAGL和KIM-1可以作为体外循环术后AKI早期诊断的敏感性和特异性较高的生物学标志物。

Objective To evaluate the value of urinary NGAL, KIM-1 and Cys C for diagnosis of acute kidney injury （AKI） after eardiopulmonary bypass. Methods 267 patients undergoing cardiopulmonary bypass were enrolled in this prospectively study. Serial urine samples were analyzed for NGAL, KIM-1 and Cys C expression. AKI was defined as a 50% or greater increase in serum crcatinine from baseline within the first 72 h after cardiopulmonary bypass. Results 54 patients developed AKI. The area under the receiver-operating characteristic curve for NGAL,KIM-1 and Cys C to predict AKI 2 h after cardiopulmonary bypass were 0.89,0.84 and 0.67,respectively. Conclusion This study suggests that urinary NGAL and KIM-1 are sensitive, specific, and highly predictive early biomarkers for AKI after cardiopulmonary bypass.