急性肾损伤因子对体外循环术后急性肾损伤的评价

Evaluation of the acute kidney injury factor in acute kidney injury after the extracorporeal circulation operation

目的：探究经体外循环心脏手术后尿液中肾损伤因子（Kim-1）的临床评价。方法随机选取2010年5~11月湖南省常德市第一人民医院经体外循环心脏手术的患者119例，通过急性肾损伤（AKI）拟定的诊断依据将其分为AKI组（59例）与非AKI组（60例）。检测并比较两组患者术前及术后2、4、6、12、24、48、72 h血肌酐（Scr）及尿Kim-1浓度。结果119例患者进行体外循环心脏手术后AKI的发病率为49.5%；AKI组术后24 h血Scr明显上升，且与同组术前及非AKI组术后24、48、72 h比较，差异均有高度统计学意义（P〈0.01）；AKI组术后4 h Kim-1浓度开始升高，且与术前及非AKI组术后4、6、12、24、48、72 h比较差异均有高度统计学意义（P〈0.01）。尿Kim-1浓度与血Scr浓度呈正相关（r=0.879，P〈0.01）。经尿Kim-1浓度诊断的AKI的ROC曲线显示可信区间为0.625~0.985（P〈0.01）。结论 Kim-1在术后4 h开始升高，术后24 h明显升高，升高时间明显早于血Scr，可作为体外循环心脏手术后AKI早期诊断更早、更敏感的指标。

Objective To explore the acute kidney injury factor （Kim-1） in the urine after the clinical application of extracorporeal circulation cardiac surgery. Methods 119 cases of patients with cardiac operation from May to November 2010 in the First People＇s Hospital of Changde City were selected, they were divided into AKI group （59 cases） and non-AKI group （60 cases）. The serum creatinine （Scr） and concentration of urine Kim-1 of patients in two groups be-fore and 2, 4, 6, 12, 24, 48, 72 h after operation were detected and compared. Results 119 patients after heart opera-tion with cardiopulmonary bypass with AKI, the incidence rate of AKI was 49.5%. The level of serum Scr of AKI group began to increase gradually 24 h after the operation, compared with before operation and non-AKI group in 24, 48, 72 h after the operation, the differences were statistically significant （P〈0.01）. The concentration of urine Kim-1 in patients began to increase gradually 4 h after the operation, compared with before operation and non-AKI group in 4, 6, 12, 24, 48, 72 h after the operation, the differences were statistically significant （P〈0.01）. There was a positive correlation be-tween the concentration of urine Kim-1 and serum Scr （r=0.879, P〈 0.01）. Confidence interval of ROC curve of AKI diagnosed by urinary Kim-1 was 0.625-0.985 （P〈0.01）. Conclusion The concentration of urine Kim-1 begin to rise in 4 hours, and 24 hours after the operation are significantly increased, obviously earlier than serum Scr, can be as a earlier and more sensitive index in the early diagnosis of AKI after extracorporeal circulation cardiac surgery.