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多项生物学标志物联合检测对心脏术后急性肾损伤早期诊断的价值 被引量：7

Value of joint detection of multiple biomarkers on early diagnosis of acute kidney injury after cardiac surgery
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摘要 目的 探讨尿金属基质蛋白酶组织抑制剂2（TIMP-2）、胰岛素样生长因子结合蛋白7（IGFBP-7）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）联合检测在心脏术后急性肾损伤（AKI）早期诊断中的价值.方法 选择2014年1-12月于南京大学医学院附属鼓楼医院行心脏手术患者311例,根据心脏术后是否发生AKI分为AKI组和非AKI组.术前和术后0、2、6、12、24、48、72 h收集血、尿标本检测并比较2组各时点血清肌酐、尿TIMP-2 、IGFBP-7与NGAL水平;以改善全球肾脏疾病预后组织的AKI定义和分级标准将AKI分为3级,比较AKI组各分级尿TIMP-2、 IGFBP-7与NGAL水平.采用受试者工作特征（ROC）曲线下面积评价3项生物学标志物单独及联合检测对AKI的诊断价值.结果 AKI发生率为19.0％ （59/311）.AKI组59例,1级33例、2级17例、3级9例;非AKI组患者252例.术前和术后24、48、72 h,AKI组血清肌酐水平明显高于非AKI组[（69±13） μmol/L比（62 ± 12） μmol/L, （112 ±10） μmol/L比（102±11） μmol/L, （125±12） μmol/L比（93±10）μmol/L,（148±15） μmol/L比（95±11） μmol/L],差异有统计学意义（P＜0.05）,2组其余各时点比较,差异无统计学意义（P＞0.05）.2组术前尿TIMP-2/尿肌酐、NGAL/尿肌酐、IGFBP-7/尿肌酐水平比较差异无统计学意义（P＞0.05）.术后2、6、12、24、48、72 h,非AKI组尿NGAL/尿肌酐、IGFBP-7/尿肌酐、TIMP-2/尿肌酐水平与术前比较[0.93（0.24,1.70） 、1.12（0.50,2.31） 、1.03（0.41,2.30） 、1.24（0.53,2.58） 、1.17 （0.51,2.40） 、1.89（0.78,2.94） μg/mg比0.87（0.31,1.68） μg,/mg, 3.18（1.79,7.51） 、3.27（1.86,6.93） 、3.59（1.73,7.11） 、3.08（1.59,6.34） 、2.65（1.24,5.49）、2.42（1.15,4.83） μg/mg比2.38（0.93,4.98） μg/mg, 0.11 （0.06,0.37）、0.13 （0.07,0.42） 、0.21（0.10,0.49）、0.17（0.09,0.38）、0.09（0.03,0.20）、0.06（0.02,0.17） μg/mg比0.05（0.01,0.14） μg/mg],差异无统计学意义（P ＞0.05） ,AKI组明显高于术前[7.68（3.46,19.01） 、16.92 （7.63,40.68） 、12.04 （5.09,26.13） 、23.81（10.72,58.91） 、19.03（8.91,40.11）、28.96（13.07,62.35）μg/mg比0.94 （0.42,2.33） μg/mg, 19.84 （2.61,40.37） 、41.56 （5.18,75.04）、62.18 （8.59,131.29）、29.33（4.81,60.27）、21.85（3.47,43.68）、10.26（2.09,21.73） μg/mg比2.57（0.61,5.19）μg/mg,0.52（0.10,1.49） 、1.15 （0.32,2.16） 、1.73 （0.46,3.01） 、1.27（0.31,2.39） 、1.09（0.31,2.17）、0.41（0.15,1.03）μg/mg比0.07（0.02,0.18） μg/mg],且AKI组明显高于非AKI组,差异有统计学意义（P＜0.05）.AKI组尿NGAL/尿肌酐、IGFBP-7/尿肌酐、TIMP-2/尿肌酐水平随着肾脏损伤程度的加重而明显升高,2、3级明显高于1级[16.04 （7.12,37.96） 、23.51（9.25,48.01） μg/mg比5.59（2.91,12.04）μg/mg,40.21（5.07,73.92） 、61.30（8.41,127.35） μg/mg比13.06（1.72,26.57） μg/mg,1.14 （0.28,1.99）、1.68 （0.39,3.17） μg/mg比0.34 （0.09,0.72） μg/mg],差异均有统计学意义（P＜0.05）.术后2h尿TIMP-2、IGFBP-7、NGAL诊断心脏术后AKI的ROC曲线下面积分别为0.77、0.81、0.69;三者联合检测,诊断敏感度和特异度分别为0.871和0.866,ROC曲线下面积为0.85,明显高于单独检测,差异有统计学意义（P＜0.05）.结论 尿TIMP-2、IGFBP-7与NGAL可以作为早期诊断心脏术后AKI的敏感指标,三者联合检测可提高诊断AKI的效能。 Objective To assess the value of joint detection of urinary tissue inhibitor of matrix Metalloproteinase-2 （TIMP-2）, insulin-like growth factor binding protein-7 （IGFBP-7） and neutrophil gelatinase associated lipocalin （NGAL） in early diagnosis of acute kidney injury （AKI） after cardiac surgery.Methods A total of 311 patients who underwent cardiac surgery firom January to Decemeber in 2014 were enrolled and divided into AKI group and non-AKI group.The levels of serum creatinine （SCr）, the levels of urinary creatinine （UCr）, TIMP-2, IGFBP-7 and NGAL were measured 0, 2, 6, 12, 24, 48 and 72 h after cardiac surgery.According to the guideline of KDIGO （Kidney Disease ： Improving Global Outcomes）, the AKI was classified into stage 1, 2 and 3, the urinary TIMP-2, IGFBP-7 and NGAL were compared between different stages.The values of joint detection and single detection of above biomarkers in diagnosing AKI were analyzed through receiver operating characteristic curve （ROC）.Results AKI occurred within 72 h after cardiac surgery in 59 patients, with incidence of 19.0%;there were 33 cases of stage 1, 17 cases of stage 2, and 9 cases of stage 3.The SCr in AKI group were significantly higher than that in non-AKI group before operation and 24, 48, 72 h after operation [（69 ± 13） μmol/L vs （62 ± 12） μmol/L, （112 ± 10） μmol/L vs （102 ± 11） μmol/L, （125 ± 12） μmol/L vs （93 ± 10） μmol/L, （148 ± 15） μmol/L vs （95 ± 11） μmol/L] （P 〈0.05）, while it was not significantly different at other time points （P 〉 0.05）.The urinary TIMP-2/UCr, urinary NGAL/UCr, urinary IGFBP-7/UCr were no significantly different between groups before operation （P 〉 0.05）.Compared with those before operation, 2, 6, 12, 24, 48, 72 h after operation, the urinary NGAL/UCr, urinary IGFBP-7/UCr, urinary TIMP-2/UCr were not significantly changed in non-AKI group [0.93 （0.24, 1.70）, 1.12 （0.50, 2.31）, 1.03 （0.41, 2.30）, 1.24 （0.53, 2.58）, 1.17 （0.51, 2.40）, 1.89 （0.78, 2.94） μg/mg vs 0.87 （0.31, 1.68） μg/mg, 3.18 （1.79, 7.51）, 3.27 （1.86, 6.93）, 3.59 （1.73, 7.11）, 3.08 （1.59, 6.34）, 2.65 （1.24, 5.49）, 2.42 （1.15, 4.83） μg/mg vs 2.38 （0.93, 4.98） μg/mg, 0.11 （0.06, 0.37）, 0.13 （0.07, 0.42）, 0.21 （0.10,0.49）, 0.17 （0.09, 0.38）, 0.09 （0.03,0.20）, 0.06 （0.02, 0.17） μg/mg vs 0.05 （0.01, 0.14） μg/mg] （P 〉 0.05）, while were significantly increased in AKI group [7.68 （3.46, 19.01）, 16.92 （7.63, 40.68）, 12.04 （5.09, 26.13）, 23.81 （10.72, 58.91）, 19.03 （8.91, 40.11）, 28.96 （13.07, 62.35） μg/mg vs 0.94 （0.42, 2.33） μg/mg, 19.84 （2.61, 40.37）, 41.56 （5.18, 75.04）, 62.18 （8.59, 131.29）, 29.33 （4.81, 60.27）, 21.85 （3.47, 43.68）, 10.26 （2.09, 21.73） μg/mg vs2.57 （0.61, 5.19） μg/mg, 0.52 （0.10, 1.49）, 1.15 （0.32, 2.16）, 1.73 （0.46, 3.01）, 1.27 （0.31, 2.39）, 1.09 （0.31, 2.17）, 0.41 （0.15, 1.03） μg/mg vs 0.07 （0.02, 0.18） μg/mg], and they were significantly higher in AKI group than those in non-AKI group （P 〈 0.05）.In AKI group, the urinary NGAL/UCr, urinary IGFBP-7/UCr, urinary TIMP-2/UCr were increased with the severity of kidney damage, significantly higher in stage 2 and 3 compared with those in stage 1 [16.04 （7.12, 37.96）, 23.51 （9.25, 48.01） μg/mg vs 5.59 （2.91, 12.04） μg/mg, 40.21 （5.07, 73.92）, 61.30 （8.41, 127.35） μg/mg vs 13.06 （1.72, 26.57） μg/mg, 1.14 （0.28, 1.99）, 1.68 （0.39, 3.17） μg/mg vs 0.34 （0.09, 0.72） μg/mg] （P 〈 0.05）.The area under ROC curves （AUC） of urinary TIMP-2, IGFBP-7 and NGAL was 0.77, 0.81,0.69, respectively.The sensitivity and specificity of joint detection in diagnosing AKI was 0.871 and 0.866;the AUC of joint detection was 0.85, significantly greater than that of single index detection （P 〈 0.05）.Conclusion The urine TIMP-2, IGFBP-7 and NGAL are sensitive in early diagnosing AKI after cardiac surgery;joint detection can improve the predictive value.
作者 王恒进 李楠 刘金春 万骋 蒋春明 葛敏 王笑云 何劲松 张苗
机构地区 南京大学医学院附属鼓楼医院肾科 南京大学医学院附属鼓楼医院药学部 南京大学医学院附属鼓楼医院心胸外科 南京医科大学肾脏病学教研室
出处 《中国医药》 2015年第11期1613-1617,共5页 China Medicine
基金 国家自然科学基金（30570862） 南京市科技发展卫生重点项目（ZKX13021） 南京市卫生青年人才资助项目（2012-2015）
关键词 急性肾损伤 心脏手术 生物学标志物 Acute kidney injury Cardiac surgery Biomarkers
分类号 R992 [医药卫生—毒理学]
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参考文献18

  • 1Petrovic S, Bogavac-Stanojevic N, Lakic D, et al.Cost-effectiveness analysis of acute kidney injury biomarkers in pediatric cardiac surgery[J].Biochem Med (Zagreb), 2015, 25(2):262-271.
  • 2Zarbock A, Meersch M, Van Aken H, et al.Urinary hyaluronic acid as an early predictor of acute kidney injury after cardiac surgery[J].J Am Coll Cardiol, 2014,64(7) :737-738.
  • 3Coca SG, Yalavarthy R, Concato J, et al.Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review[J].Kidney Int, 2008,73 (9) : 1008-1016.
  • 4Arun O, Celik G, Oc B, et al.Renal effects of coronary artery bypass graft surgery in diabetic and non-diabetic patients: astudy with urinary neutrophil gelatinase-associated lipocalin and serum cystatin C[J].Kidney Blood Press Res, 2015,40(2) :141-152.
  • 5McIlroy DR, Farkas D, Matto M, et al.Neutrophil gelatinase-associated lipocalin combined with delta serum creatinine provides eadyrisk stratification for adverse outcomes after cardiac surgery: a prospective observational study[J].Crit Care Med, 2015,43 (5): 1043-1052.
  • 6贺建勋,袁慧.中性粒细胞明胶酶相关脂质运载蛋白对冠状动脉旁路移植术后急性肾损伤的早期诊断价值[J].中国医药,2014,9(6):795-799. 被引量：3
  • 7Okusa MD, Davenport A.Reading between the (guide) lines-the KDIGO practice guideline on acute kidney injury in the individual patient[J].Kidney Int, 2014,85(1) :39-48.
  • 8Reddy SL, Grayson AD, Griffiths EM, et al.Logistic risk model for prolonged ventilation after adult cardiac surgery[J].Ann Thorac Surg, 2007,84 (2) :528-536.
  • 9杨清,周玉杰,刘晓丽,聂斌,杨士伟,张建维.胱蛋白酶抑制素C对冠心病合并肾功能不全患者对比剂急性肾损伤的诊断价值[J].中国医药,2013,8(5):589-591. 被引量：4
  • 10Che M, Xie B, Xue S, et al.Clinical usefulness of novel biomarkers for the detection of acute kidney injury following elective cardiac surgery[J].Nephron Clin Pract, 2010,115(1) :c66-72.

二级参考文献42

  • 1Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney InjuryNetwork: report of all initiative to improve outcomes in acutekidney injury. Crit Care, 2007, 11: R31-R38.
  • 2Srisawat N, Wen X, Lee M,et al. Urinary biomarkers andrenal recovery in critically ill patients with renal support. ClinJ Am Soc Nephrol, 2011, 6: 1815-1823.
  • 3Che M, Xie B, Xue S, et al. Clinical usefulness of novelbiomarkers for the detection of acute kidney injury followingelective cardiac surgery. Nephron Clin Pract, 2010,115: c66-c72.
  • 4Ling W, Zhaohui N, Ben H, et al. Urinary IL-18 and NGAL asearly predictive biomarkers in contrast . induced nephropathyafter coronary angiography. Nephron Clin Pract, 2008,108:cl76-cl81.
  • 5Dent CL, Ma Q, Dastrala S, el al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury,morbidityand mortality after pediatric cardiac surgery : a prospectiveuncontrolled cohort study. Crit Care, 2007,11: R127.
  • 6Niekolas TL, O'Rourke MJ, Yang J, el al. Sensitivity andspecificity of a single emergency department measurement ofurinary neutrophil gelatinase - associated lipocalin for diagnosingacute kidney injury. Ann Intern Med, 2008,148: 810-819.
  • 7Haase M, Bellomo R, Devarajan P,et al. Accuracy ofneutrophilg gelatinase - associated lipocalin (NGAL) in diagnosisand prognosis in acute kidney injury: a systematic review andmeta-analysis. Am J Kidney Dis, 2009, 54: 1012-1024.
  • 8Ahlstrom A, Tallgren M, Peltonen S,et al. Evolution andpredictive power of serum cystatin C in acute renal failure.Clin Nephrol, 2004, 62: 344-350.
  • 9Kwon SH, Hyun J,Jeon JS, et al. Subtle change of cystatin C,with or without acute kidney injury, associated with increasedmortality in the intensive care unit. J Crit Care, 2011,26: 566-571.
  • 10Haase - Fielitz A, Bellomo R,Devarajan P, et al. Novel andconventional serum biomarkers predicting acute kidney injuryin adult cardiac surgery - a prospective cohort study. Crit CareMed, 2009, 37: 553-560.

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同被引文献90

  • 1吴万垠,王斌,张海波,柴小姝,龙顺钦,邓宏,罗海英,李柳宁,刘伟胜.参附注射液对TP方案治疗非小细胞肺癌减毒作用的研究[J].广州中医药大学学报,2006,23(5):387-390. 被引量：11
  • 2Mehta RH, Honeycutt E, Patel UD, et al. Impact of recovery of renal function on long-term mortality after coronary artery bypass grafting[J]. Am J Cardiol, 2010, 106(12) : 1728-1734. DOI: 10. 1016/j. amjcard. 2010.07. 045.
  • 3Tolpin DA, Collard CD, Lee VV, et al. Subclinical changes in serum creatinine and mortality after coronary artery bypass gvafting[J]. J Thorac Cardiovasc Surg, 2012, 143 ( 3 ) : 682-688. DOI: 10.lO16/j, jtcvs. 2011.09.044.
  • 4Howell N J, Freemantle N, Bonser RS, et al. Subtle changes in renal function are associated with differences in late survival following adult cardiac surgery [ J ]. Eur J Cardiothorac Surg, 2012, 41 ( 4 ) : e3842. DOI: 10. 1093/ejcts/ezr329.
  • 5Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review [ J ]. Kidney Int, 2008, 73 (5) :538-546. DOI : 10. 1038/@ ki. 5002743.
  • 6Tian J, Barrantes F, Amoateng-Adjepong Y, et al. Rapid reversal of acute kidney injury and hospital outcomes: a retrospective cohort study[J]. Am J Kidney Dis, 2009,53(6) :974-981. DOI: 10. 1053/j. ajkd. 2009.02. 007.
  • 7Coca SG, Yusuf B, Shlipak MG, et al. Long-term risk of mortality and other adverse outcomes after acute kidney injury: A systematic review and meta-analysis [ J ]. Am J Kidney Dis, 2009,53 ( 6 ) : 961-973. DOI: 10. 1053/j. ajkd. 2008.11. 034.
  • 8Hobson CE, Yavas S, Segal MS, et al. Acute kidney injury is as- sociated with increased long-term mortality after cardiothoracic surgery [ J ]. Circulation, 2009,119 ( 18 ) : 2444-2453. DOI : 10. 1161/CIRCULATIONAHA. 108. 800011.
  • 9Kidney Disease: Improving Global Outcomes(KDIGO) Acute Kid- ney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury [ J ]. Kidney Int, 2012,2 ( Suppl ) : 1-138.
  • 10Harrell FE Jr, Califf RM, Pryor DB, et al. Evaluating the yield of medical tests[J]. JAMA, 1982,247(18) :2543-2546. DOI: 10. 1001/jama. 1982. 03320430047030.

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中国医药
2015年 第11期

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