尿β_2-微球蛋白与视黄醇结合蛋白及N-乙酰-β-D-氨基葡萄糖苷酶诊断成人心脏术后早期急性肾损伤的价值

Value of urine β_2-microglobulin,urine retinol binding protein and N-acetyl-β-D-glucosaminidase to the diagnosis of early acute kidney injury after heart surgery in adult patients

目的 探讨尿β_2-微球蛋白（β_2-microglobulin,β_2-MG）、尿视黄醇结合蛋白（retinol-binding protein,RBP）、尿N-乙酰-β-D-氨基葡萄糖苷酶（N-acetyl-β-D-glucosaminidase,NAG）在成人心脏手术后急性肾损伤（acute kidney injury,AKI）早期诊断中的价值。方法 行心脏手术患者60例,分别于术前及术后24、48、72h采用ELISA法检测尿β_2-MG、RBP水平,采用对硝基苯酚比色法检测尿NAG水平,采用酶法检测血清肌酐（serum creatinine,SCr）。以术后48h血清SCr较基础值增加≥50%为AKI判定标准,将60例患者分为AKI组41例,非AKI组19例,比较2组手术前、后尿β_2-MG、RBP、NAG水平变化;绘制ROC曲线,以AUC评价各标志物诊断AKI的效能。结果 2组术前尿β_2-MG、RBP、NAG水平比较差异均无统计学意义（P〉0.05）,AKI组术后24、48、72h尿β_2-MG[（1.010±0.137）、（1.803±0.278）、（0.783±0.619）mg/L]、RBP[（0.384±0.336）、（0.468±0.418）、（0.383±0.359）mg/L]、NAG[（29.276±23.406）、（33.275±26.175）、（36.404±22.903）u/L]及血清SCr[（71.529±18.666）、（91.930±32.017）、（89.135±44.988）μmol/L]较非AKI组[β_2-MG（0.168±0.150）、（0.227±0.155）、（0.160±0.124）mg/L,RBP（0.228±0.165）、（0.150±0.147）、（0.138±0.118）mg/L,NAG（10.441±5.535）、（13.900±8.243）、（11.940±6.307）u/L,SCr（64.517±17.392）、（68.761±20.176）、（64.268±19.119）μmol/L]明显增高,差异均有统计学意义（P〈0.01）;术后48h尿β_2-MG的AUC最大为0.822,95%CI：0.765~0.890,尿RBP的AUC为0.778,95%CI：0.701~0.878;术后72h尿NAG的AUC最大为0.850,95%CI：0.774~0.927。结论 成人心脏手术后发生AKI者尿β_2-MG、RBP及NAG水平明显增高;尿β_2-MG、RBP诊断心脏手术后AKI的最佳时间点为术后48h,尿NAG为术后72h。

Objective To explore the value of β2-microglobulin （β2-MG）, urine retinol-binding protein （RBP） and urine N-acetyl-β-D-glucosaminidase （NAG） to the diagnosis of early acute kidney injury （AKI） after heart surgery in adult patients. Methods Sixty adult patients undergoing heart surgery were detected the levels of urine β2-MG and RBP by ELISA, were detected urine NAG by colorimetry of p-nitrophoenol, and were detected serum creatinine （SCr） by enzyme method before, and 24, 48 and 72 hours after operation. The SCr level increased by ≥50% 48 hours after operation as AKI standard definition, 60 patients were divided into AKI group （n= 41） and non-AKI group （n= 19）. The levels of β2-MG, RBP and NAG were compared before and after operation between two groups. ROC was drawn and AUC was used to assess the diagnosis efficiency of the markers for the diagnosis of AKI. Results There were no significant differences in the levels of 132-MG, RBP and NAG between two groups before operation （P〉0.05）. The levels of urine β2-MG （（1.010±0. 137）, （1. 803±0. 278）, （0. 783±0. 619） mg/L）, RBP （（0. 384±0. 3360, （0. 468±0. 418）, （0.383±0.359） mg/L）, NAG （（29. 276±23. 406）, （33. 275±26. 175）, （36. 404±22. 903） u/L）,and SCr （71. 529± 18.666）, （91. 930±32. 017）, （89. 135±44. 988） μmol/L in AKI group 24, 48 and 72 hours after operation were significantly higher than those in non-AKI group β2-MG.. （0. 168±0. 150）, （0. 227±0. 155）, （0. 160±0. 124） mg/L; RBP： （0.228±0. 165）, （0. 150±0. 147）, （0. 138±0. 118） mg/L; NAG： （10. 441±5. 535）, （13. 900±8. 243）, （11. 940±6. 307） u/L） ; SCr： （64. 517±17. 392）, （68. 761±20. 176）, （64. 268±19. 119） vmol/L） （P〈0.01）. AUC of urine β2-MG 48 hours after operation was （0. 822, 95% CI： O. 765 to 0. 890）, of urine RBP 48 hours after operation was 0. 778 （95%CI： 0. 701 to 0. 878）, and urine NAG 72 hours after operation was 0. 850 （95%CI： 0. 774 to 0. 927）. Conclusion The levels of β2-MG, RBP and NAG increase obviously in AKI patients after adult heart operation. The levels of β2-MG and RBP 48 hours after operation and urine NAG level 72 hours after operation are the optimal time points for AKI.