胱抑素C在儿童先天性心脏病介入封堵术相关造影剂致急性肾损伤中的诊断价值

Diagnostic Value of Cystain C in Contrast Associated Acute Kidney Injury after Transcatheter Closure for Children with Congenital Heart Disease

目的了解胱抑素C(SCys-C)在儿童先天性心脏病介入封堵术相关造影剂致急性肾损伤中的诊断价值。方法选择2013年四川大学华西第二医院介入封堵术的先天性心脏病患儿(室间隔缺损、动脉导管未闭)128例,于术前,术后24h、48h分别抽血检测尿素氮(BUN)、血清肌酐(SCr)和SCys-C等。根据急性肾损伤(AKI)网络的AKI诊断标准,将AKI患儿分为肾功能1期和肾功能2期,比较AKI患儿(n=16)和非AKI患儿(n=112)之间及不同分期AKI患儿之间的肾功能指标及SCys-C浓度差异。采用受试者工作特征(ROC)曲线计算SCys-C诊断儿童急性肾损伤的临界点。结果 AKI组的SCr、SCys-C高于非AKI组(P<0.05),BUN表达两组比较差异无统计学意义(P>0.05)。肾功能1期与肾功能2期患者比较仅SCys-C的表达差异有统计学意义(P<0.05)。根据曲线下面积(AUC)判断,SCys-C于术后24h即可发现AKI的发生(P<0.05),术后24h的SCys-C临界值在1.055mg/L可获得最大约登指数。术后48h的SCys-C的AUC与术后24h差异无统计学意义,诊断价值相当(P>0.05)。术后24h的SCr不能发现AKI的发生(P>0.05),但术后48h可发现AKI(P<0.05)。同时点比较,SCys-C诊断价值均优于SCr,差异有统计学意义(P<0.05)。结论儿童先天性心脏病介入封堵术相关造影剂可增加儿童急性肾损伤的风险,SCys-C是其重要筛选指标之一并有助于早期诊断,其术后24h的临界值为1.055mg/L。

Objective To investigate the diagnostic value of cystain C（SCys-C）in contrast associated acute kidney injury（AKI）after transcatheter closure for children with congenital heart disease.Methods There were128 children with congenital heart disease（interventricular septal defect or patent ductus arteriosus）underwent transcatheter closure in West China Second University Hospital during 2013.Blood urea nitrogen（BUN）,serum creatinine（SCr）and SCys-C were examined before surgery and at 24 and 48hafter surgery.The incidence of AKI was calculated.The children were divided into two groups according to glomerular filtration rate：AKI group（renal function stage 1,renal function stage 2subgroups）and non-AKI group.Differences in renal function indexes and SCys-C were compared between AKI group（n=16）and non-AKI group（n=112）,renal function stage 1and stage2 subgroups.ROC curve analysis was used to calculate the cut-off value of SCys-C in the diagnosis of AKI.Results The levels of SCr and SCys-C in AKI group were significantly higher than those in non-AKI group（P〈0.05）.However,there was no significant difference in BUN between the two groups（P〉0.05）.Only SCys-C had a significant difference between renal function stage 1and stage 2subgroups（P〈0.05）.The cut-off value of 24 h SCys-C in the diagnosis of AKI was 1.055 mg/L according to area under curve（AUC）.AUCindicated that AKI could be diagnosed earlier with SCys-C than SCr（P〈0.05）.Conclusion The contrast agent could increase the risk of child AKI after transcatheter closure for congenital disease children.SCys-C is an important index for this risk with its cut-off value of 1.055mg/L at 24hpost-surgery.