KIM-1及NGAL在婴幼儿复杂先心病术后早期肾功能损伤中的预测作用

Early prediction values of detecting KIM-1 and NGAL in acute kidney injury after complex congenital heart disease surgery

目的探讨尿中肾脏损伤分子-1(Kidney injury molecule-1,KIM-1)及中性粒细胞明胶酶相关脂质运载蛋白(reutrophil gelatinase-associated lipocalin,NGAL)在复杂先心病根治术后急性肾功能损伤评估中(acute kidney injury,AKI)的敏感性及临床价值。方法回顾性分析本院2011年12月年至2014年12月收治的复杂先心病术后急性肾功能衰竭患儿临床资料,共23例,其中男性15例,女性8例,年龄4~18个月,平均年龄(8.38±1.75)个月,体重3~14kg,平均体重(5.15±3.82)kg,观察术前、术后2 h、4 h、6h内尿中NGAL、KIM-1及血肌酐、尿素氮、K^+、平均动脉压及尿量的变化。结果术后2 h尿液中NGAL开始上升,为(1.28±0.63)ng/L,术后4 h尿液中KIM-1上升,为(1.14±0.16)ng/L,与手术前比较,差异有统计学意义。经积极干预治疗后,23例患儿中,19例存活,4例因多器官功能衰竭而死亡。结论尿中KIM-1及NGAL有助于复杂先心病术后急性肾功能损伤的早期检测,可为临床治疗提供重要线索。

Objetive To explore the clinical values of kidney injury molecule — 1 and neutrophil gelati-nase-associated lipocalin （NGAL）in acute kidney injury （AKI）after complex congenital heart disease surger-y.Methods A total of 23 surgical patients （15 males,8 females）of complex congenital heart disease were enrolled between December 2011 and December 2014.Their average age was （8.38 ±1.75）（4 ~18）months and mean body weight （5.15 ±3.82）kg.At preoperative and 2 h,4 h,6 h post-operation,the changes of KIM— 1,NGAL in urine and blood urea,serum creatinine,potassium ion,mean arterial pressure and total a-mount of urine were recorded. Results NGAL began to rise in 2 h post-operation.And KIM—1 rose in 4h af-ter operation.Compared with preoperation,the differences were statistically significant.Through active inter-ventions,19 patients survived.And 4 patients died from multiple failures. Conclusions The levels of KIM—1 and NGAL may be useful for an early diagnosis and therapy of AKI for complex congenital heart disease.