胱抑素C和肾损伤分子-1对先天性心脏病体外循环术后急性肾损伤的早期预测价值

Value of cystatin C and KIM-1 in early prediction of acute kidney injury after cardiopulmonary bypass in patients with congenital heart disease

目的探讨胱抑素C(Cys C)和肾损伤分子-1(KIM-1)对先心病(先天性心脏病)体外循环术后急性肾损伤的早期预测价值。方法选取2014年5月-2014年10月,该院100例先心病体外循环手术患者,根据急性肾损伤诊断标准,将其分为急性肾损伤组(AKI,26例)和非急性肾损伤组(非AKI组,74例),检测和比较两组患者Cys C、KIM-1、KIM-1/Ucr水平,KIM-1与Cys C的相关性,探讨KIM-1联合Cys C检测对AKI的诊断价值。结果与术前相比,术后6、12、24及48 h AKI组KIM-1水平均明显升高(P<0.05),且术后12 h达峰值,而非AKI组KIM-1水平变化不明显(P>0.05)。与非AKI组相比,AKI组术后6、12、24及48 h AKI组KIM-1水平均明显提高(P<0.05);与术前相比,术后2、6、12、24及48 h AKI组Cys C水平均明显提高(P<0.05),且术后12 h达峰值,而非AKI组Cys C水平变化不明显(P>0.05)。与非AKI组相比,AKI组术后2、6、12、24及48 h AKI组Cys C水平均明显提高(P<0.05);KIM-1/Ucr变化趋势与KIM-1完全相同;KIM-1与Cys C呈正相关;KIM-1联合Cys C检测时,ROC曲线下面积最大,特异度为97.36%。结论先心病患者体外循环术后容易发生AKI,KIM-1联合Cys C检测对AKI具有早期预测价值。

【Objective】 To study the early predictiion value of cystatin C（Cys C） and kidney injury molecule-1（KIM-1） on acute kidney injury（AKI） after cardiopulmonary bypass for patients with congenital heart disease. 【Methods】 The 100 patients with congenital heart disease after cardiopulmonary bypass in our hospital from May 2014 to Oct. 2014 were divided into AKI group（26 cases） and non-AKI group（74 cases）according to the diagnostic criteria of AKI. The levels of Cys C, KIM-1 and KIM-1/Ucr in both groups were measured and compared. The correlation between KIM-1 and Cys C was analyzed. The value of KIM-1combined with Cys C in diagnosis of AKI was researched. 【Results】 In the AKI group, the level of KIM-1at postoperative 6, 12, 24 and 48 h significantly increased compared to the pre-operative value（P 〈 0.05） with the peak at postoperative 12 h. The level of KIM-1 in the non-AKI group had no obvious change（P 〉 0.05）.Compared with the non-AKI group, the level of KIM-1 at postoperative 6, 12, 24 and 48 h in the AKI group were significantly increased（P 〈 0.05）. In the AKI group, the level of Cys C at postoperative 2, 6, 12, 24 and48 h significantly increased compared to the pre-operative value（P 〈 0.05） with the peak at postoperative 12 h.The level of Cys C in the non-AKI group had no obvious change（P 〉 0.05）. Compared with the non-AKI group, the level of Cys C at postoperative 2, 6, 12, 24 and 48 h in the AKI group significantly increased（P 〈0.05）. The change trend of KIM-1/Ucr was the same as KIM-1. KIM-1 was in a positive correlation with Cys C. The area under ROC curve was the largest with specificity of 97.36% when the measurement of KIM-1was combined with Cys C. 【Conclusion】 Patients with congenital heart disease are prone to AKI after cardiopulmonary bypass. KIM-1 combined with Cys C detection has the early predictive value of AKI.