KIM-1检测冠脉造影后造影剂肾病的前瞻性研究

Prospective Study of Monitoring of Kidney Function by Kidney Injury Molecule-1 in Patients with Contrast Induced Nephropathy after Coronary Angiography

目的造影剂肾病是常见的医源性肾损伤,血肌酐是观察肾脏功能最常用指标,但是它对急性肾损伤的反应比较迟钝,而且肌酐水平受到许多因素的影响。本研究探讨KIM-1检测在诊断早期冠脉造影后出现的急性肾损伤中的意义。方法本研究前瞻性收集心内科冠脉造影69例造影剂危险积分≥6分或eGFR≤60 ml/min的高危患者,并且收录其临床资料包括既往史、病史、诊断、化验、用药记录、辅助检查结果以及冠脉造影记录。收集患者术前血、尿,术后3,6,12,24小时尿以及术后1,2,3天血,采用ELISA法测定69例行冠脉造影的高危患者术后尿KIM-1水平,并与血肌酐进行相关分析,了解其诊断CIN的特异度以及灵敏度。结果 Pearson检验结果提示术前术后KIM-1(R=0.230、P=0.049)变化与肌酐变化呈直线正相关。在诊断CIN上,NGAL的特异度为95.2%,敏感度为75%。结论在急性肾损伤新型生物指标中,KIM-1是比较好的指标,能较早诊断CIN。

Objective To explore the effect of monitoring the kidney function by kidney injury molecule-1 （ KIM-1 ） on the early diagnosis of contrast induced nephropathy （CIN） after the coronary angiography （CAG）. Methods The clinical data such as past and present history, diagnosis, laboratory result, drug usage, result from cardio-echogram and DSA were collected in 69 CAG/PCI patients with CIN risk score≥6 or eGFR≤〈60 ml/min. The urine samples were collected before the procedure and on 3,6,12 and 24 hours after the operation;while the blood samples were collected before the procedure and on dl ,d2 and d3 after the operation. KIM-1 levels in urine were tested by ELISA, and its correlation with the levels of serum creatinine（SCr） was analyzed by Pearson＇ s correlation. Results The level of KIM-1 before and after CAG positively correlated with SCr by the linear relationship. In diagnosing CIN, the specificity and sensitivity of KIM-1 has a specificity of 95.2% and sensitivity of 75%. Concluo sion KIM-1 is a better biomarker in terms of early diagnosis of CIN.