补体应答基因-32在儿童急性肾损伤中的早期预测价值

Effects of response gene to complement 32 as a new biomarker in children with acute kidney injury

目的 探讨血清补体应答基因-32（RGC-32）在儿童急性肾损伤（AKI）中的早期预测价值.方法 选择2013年3至6月在上海交通大学附属儿童医院住院并接受心肺分流术（CPB）的67例先天性心脏病患儿为CPB组,参照pRIFLE标准分为AKI组（23例）及非AKI组（44例）.选取同期同年龄段健康体检儿童30名作为对照组.动态观察CPB组患儿术前、术后30 min、2h、4h、24h、48 h、72 h血清RGC-32、肌酐（Scr）及胱抑素C（CysC）水平.应用受试者工作特征曲线（ROC）及曲线下面积（AUC）评价并比较三者早期预测AKI发生的敏感性和特异性.结果 23例AKI患儿的pRIFLE分期：危险期15例,损伤期4例,衰竭期3例,丧失期1例.AKI组血清RGC-32于术后30 min即显著升高,明显高于非AKI组差异有统计学意义[（2.88±0.68） μg/Lvs.（1.39±0.31）μg/L,P＜0.05].术后2h、4h、24 h、48 h,AKI组血清RGC-32浓度仍持续高于非AKI组,差异均具有统计学意义（t=2.180、2.818、2.226、3.017,P均＜0.05）;CPB术后30 min、2h、4h、24 h、48 h、72 h血清RGC-32预测AKI发生的AUC分别为0.770、0.707、0.768、0.728、0.723、0.770,均＞0.7;CPB术后30 min、2h、4h血清RGC-32敏感性为0.914、0.824、0.824,特异性为0.619、0.667、0.810,CPB术后30 min、2h、4 h CysC敏感性为0.625、0.813、0.813,特异性为0.571、0.619、0.571;术后30 min、2h、4 h Scr敏感性为0.625、0.625、0.813,特异性为0.571、0.571、0.524.结论 与CysC、Scr相比,血清RGC-32可更早预测AKI发生,能否作为一种新型早期诊断AKI的生物标志物,尚需进一步验证.

Objective To investigate the new biomarkers of acute kidney injury,as well as to confirm the values of response gene to complement 32 （RGC-32） for early diagnosis of acute kidney injury by comparing the values of serum creatinine （Scr） and cystatin C （CysC） in children who had undergone cardiopulmonary bypass （CPB）.Method Sixty-seven patients who had accepted CPB were recruited from the cardiac surgery intensive care unit,Children＇s Hospital Affiliated to Shanghai Jiao Tong University from March to June 2013 and assigned to acute kidney injury group （group AKI） or non-acute kidney injury group （group non-AKI）,on the basis of the definition by the pediatric RIFLE （pRIFLE） criteria.Also 30 healthy control children were recruited.Serum samples were taken regularly from each patient after CPB at 30 min,2 h,4 h,24 h,48 h and 72 h for RGC-32.Serum samples were tested by enzyme linked immunosorbent assay （ELISA） which was employed to determine the levels of serum RGC-32.Scr and CysC were analyzed by HITACHI 7180 automatic biochemical analyzer.All the data were analyzed by receiver operator characteristic curve （ROC） and area under curve （AUC）.Result The incidence of AKI was 34% （23/ 67）,including 15 cases with risk stage AKI,4 cases with injury stage AKI,3 cases with failure stage AKI,1 cases with loss stage AKI.Three out of four subjects with Failure stage AKI and the one case with Loss stage all accepted renal replacement therapy.CPB group had a higher level of serum RGC-32 than that of pre-operation after CPB 30 minute [（2.88 ±0.68） μg/L vs.（1.39 ±0.31） μg/L,P 〈0.05].At the same time,comparing with the non-AKI group,the levels of serum RGC-32 were higher than that of controls 30 min,2 h,4 h,24 h and 48 h after CPB （t =2.560,2.180,2.818,2.226,3.017 ; P 〈 0.05）.The values for the AUC were determined for RGC-32 as 0.770,0.707,0.768,0.728,0.723 and 0.770 after CPB 30 min,2 h,4 h,24 h,48 h and 72 h.The values for sensitivity of serum RGC-32 30 min,2 h and 4 h after CPB was 0.914,0.824,0.824 and the values for specificity of serum RGC-32 was 0.619,0.667,0.810,respectively.But the values for sensitivity of CysC was 0.625,0.813,0.813,and specificity 0.571,0.619,0.571,respectively.The values for sensitivity of Scr was 0.625,0.625,0.813 and specificity was 0.571,0.571,0.524,respectively.Conclusion The sensitivity of serum RGC-32 for detecting AKI was much higher than that of Scr and serum CysC in children who had accepted CPB,and that RGC-32 may be a new biomarker for early detection of AKI.However,the conclusion needs to be further elucidated.