尿肾损伤分子-1对肺移植术后早期并发急性肾损伤患者的早期诊断

Urine kidney injury molecule - 1 in the early diagnosis of early - stage acute kidney in- jury after lung transplantation

目的探讨尿肾损伤分子-1（KIM-1）在肺移植术后急性肾损伤（AKI）中的早期诊断价值。方法前瞻性收集本院52例肺移植手术患者在手术前后不同时相的血、尿标本，分别测定血肌酐（Scr）和尿KIM-1。根据AKI的诊断标准，将患者分为AKI组和非AKI组，观察两组Scr和尿KIM～1的动态变化。用受试者工作特征曲线（ROC）评价尿KIM-1对AKI的诊断作用。结果52例患者中，术后发生AKI的有19例，发生率为36．5％。AKI组Scr在术后的第24h上升至基础值的1．80倍，达到AKI的诊断标准。AKI组术后4h尿KIM-1较基线值明显上升[（1．7±0．6）ng／mL比（0．5±O．3）ng／mL，P〈0．05]。术后4h，尿KIM-1的ROC曲线下面积为0．837，95％的可信区间为0．729～0．946，以1．6ng／mL作为AKI的诊断界限时，敏感性和特异性分别为73．7％和75．8％。结论尿KIM-1可较Scr更早诊断肺移植术后AKI的发生。尿KIM-1可能为肺移植术后并发AKI患者的早期诊断的标记物。

Objectives To investigate the value of kidney injury molecule - 1 （ KIM - 1 ） in the early diag- nosis of early - stage acute kidney injury （AKI） in patients after lung transplantation. Methods 52 lung trans- plantation patients hospitalized were enrolled in this prospective study. Blood and urine samples were collected before and at different time points after surgery. The concentrations of serum creatinine （Scr） and urine KIM - 1 were meas- ured. According to AKI criteria, patients were divided into the AKI group and non - AKI group. Dynamic changes of levels of Scr and urine KIM - 1 were observed in two groups. The receiver operating characteristic curve was used to evaluate the early diagnostic value of urine KIM - 1. Results 19 （ 36.5 % ） patients developed AKI after lung transplantation. 2gh after surgery, the level of Scr rose to 1.80 times of the baseline, which met the diagnostic crite- ria of AKI. In the AKI group, concentrations of urine KIM - 1 at 4h time point began to rise significantly from base- line [ （ 1.7 ＋ 0.6） ng/mL versus （0.5 4- 0.3 ） ng/mL, P 〈 0.05 ]. At 4h time point after lung transplantation, the area under the curve of urine KIM - 1 was 0. 837 （95 % CI 0. 729 ~ 0. 946 ） , the sensitivity was 73.7 % and specific- ity was 75.8% with a cutoff value of 1.6rig/mL. Conclusions Urine KIM - 1 can diagnose AKI after lung transplantation earlier than Ser, which may be a good biomarker for early diagnosis of AKI after lung transplantation.