多项指标联合检测在成人心脏手术后急性肾损伤早期诊断中的价值

Effects of combination determination of multiple indexes on early diagnosis of acute kidney injury after adult heart surgery

目的探讨尿中肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素-18(IL-18)、半胱氨酸蛋白酶抑制剂C(Cys-C)联合检测在成人心脏手术后急性肾损伤(AKI)早期诊断中的价值。方法选择2010年1月至2011年12月西安交通大学医学院第一附属医院心脏手术患者1 160例,将其中发生AKI的30例患者作为实验组,并选择临床资料相匹配的未发生AKI的30例患者作为对照组。收集两组患者术前及术后多时间点的血、尿标本,观察两组患者血清肌酐(Scr)和尿Cys-C、KIM-1、NGAL、IL-18的动态变化,运用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析评价4项指标联合检测对AKI的诊断效能。结果 (1)术后72 h内两组患者血清Scr值差异无统计学意义(P>0.05)。(2)与对照组比较,实验组患者尿KIM-1术后6 h升高,24 h达峰值;NGAL术后2 h升高,6 h达峰值,差异有统计学意义(P=0.000);尿Cys术后6 h升高,24 h达峰值;尿IL-18变化曲线与尿KIM-1相似。(3)各指标峰值ROC曲线分析以KIM-1的AUC值最高。(4)判别分析表明24 h时4项指标联合检测对AKI的总判对率为90.0%。结论尿KIM-1、NGAL、IL-18和Cys-C联合检测能够在24 h内诊断AKI。

Objective To investigate the value of joint detection of Cys-C, KIM-1, NGAL and IL-18 in urine for early di- agnosis of acute kidney injury （AKI） after adult heart surgery. Methods 1 160 qualified patients with cardiac operation in the First Affiliated Hospital of Medical College of Xian Jiaotong University from Janaury 2010 to December 2011 were collected. A- mong them, AKI ocurred in 30 cases as the experimental group and other 30 cases of matched clinical data without AKI were se- lected as the control group. The blood and urine specimens at multiple timepoints before and after operation were collected in the two groups for observing the dynamic changes of Scr and urine Cys-C,KIM-1 ,NGAL and IL-18. The diagnostic efficiency of 4 in dexes combination detection to AKI was analyzed and evaluated with the receiver operating characteristic （ROC） curve and the area under curve （AUC）. Results （1）Within postoperative 72 h,the serum creatinine level had no difference between the two groups. （2）Compared with the control group, urine KIM-1 in the experimental group was increased after 6 h and reached the peak value at 24 h;NGAL was increased at postoperative 2 h and reached the peak value at 6 h;urine Cys was increased at postopera- tive 6 h and reached the peak value at 24 h;the change curve of urine IL-18 was similar to KIM-1. （3）The analysis on the ROC curve of various indexes peak value showed that AUC of KIM-1 was highest. （4）The discriminatory analysis revealed that the 4-in- dex combination detection at 24 h to AKI had the right judging rate of 90.0%. Conclusion The combined detection of urine KIM-1 ,NGAL,IL-18 and Cys-C can diagnose AKI within 24 h.