联合标志物检测在成人心脏手术后早期急性肾损伤中的诊断价值

Diagnostic value of joint marker detection in the early acute kidney injury after adult cardiac surgery

目的探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）、尿肾损伤分子-1（Kim-1）、尿N-乙-p—D-氨基葡萄糖苷酶（NAG）、尿胱蛋白酶抑制剂C（CystC）在成人心脏手术后急性肾损伤（AKI）早期诊断的敏感性及联合应用的临床价值。方法选择2010年1月至2011年6月在我院心脏外科行心脏手术的住院患者105例，并收集手术前和手术后24、48、72h的血、尿标本，分别测定尿NGAL、Kim-1、NAG、CystC及血肌酐，血肌酐较基础值增加t〉50％的65例为AKI组，其余40例为非AKI组，观察两组患者尿NGAL、Kim-1、NAG、CystC的变化。尿NGAL、Kim-1、CystC测定采用酶联免疫法，尿NAG测定采用对硝基苯酚（PNP）比色法，血肌酐采用比浊法检测。并以受试者工作特征曲线及曲线下面积（AUC）评价各项标志物单独和联合应用时诊断AKI的价值。结果两组患者术前血肌酐及尿NGAL、KIM-1、NAG及CystC比较差异均无统计学意义（P均〉0．05），AKI组的各项生物学标志物分别在术后24、48、72h较非AKI组升高，差异存在统计学意义（P均〈0．001）。与术前比较，AKI组尿NAG、CystC、NGAL、KIM-1术后24、48、72h明显升高，差异均有统计学意义（P均〈0．001），联合以上4种尿生物标志物的最佳诊断时间点为术后48h，得到的AUC为0．901（95％C10．769～0．938）。结论心脏手术后AKI患者各项生物学标志物在术后不同的时间点显著升高，联合标记物的检测可以作为成人心脏手术后AKI的早期诊断方法。

Objective To explore the sensitivity and clinical value of combined detection of urine NGAL, Urine Kim-1, Urine NAG, urine Cystatin C in early acute kidney injury after adult cardiac surgery. Methods A hundred-five patients who underwent cardiac surgery in the department of heart surgery in the People＇s Hospital of the Xinjiang Uygur Autonomous Region from January 2010 to June 2011 were collected as subjects. Blood and lurine specimens before operation and 24,48 and 72 hours after the operation were collected, urine NGAL, Kim-1, NAG, Cyst C and serum SCr levels were determined. According to AKI standard, 65 patients were recruited into AKI group（ serum SCr value increased by 50% ）, and the rest 40 patients were in non-AKI group. The changes of the parameters were recorded and analyzed. Urine NGAL, Kim-1, Cyst C were respectively determined by enzyme linked immuno sorbent assay （ELISA）. The urine NAG was determined by nitro phenol （PNP） colofimetric detection. The SCr were detected by turbidity method. The individual and combined diagnostic values of these parameters for AKI were assessed using receiver-operating characteristic （ROC） curve and the area under the curve （AUC）. Results There was no significant difference on SCr, NGAL, KIM-1, NAG and CystC between wo groups before operation （ P 〉 0. 05 ）, The level of each biological marker was significantly increased in AKI group than that in none AKI group at different time points after operation（ P 〈 0. 001 ）. The levels of NAG, CystC, NGAL and KIM-1 in the AKI. group were significantly higher at 24,48, and 72 hours after surgery than those before surgery （P 〈 0. 001 ）. Giving a comprehensive evaluation, the above four parameters were at their best sensitivity at 48 hours after surgery,with an AUC of 0. 901 （95% CI;0. 769 - 0. 938）. Conclusion The biological markers of AKI in heart surgery patients are significantly increased after operation. Joint marker detection can be used in the early diagnosis of AKI after adult heart surgery.