探讨KIM-1及cTnT对Ⅰ型心肾综合征的诊断价值

Diagnostic Value of Kidney Injury Molecule-1 and Troponin T in Patients With Type Ⅰ Cardiorenal Syndrome

目的探讨肾损伤分子-1(KIM-1)、肌钙蛋白(cTnT)在诊断Ⅰ型心肾综合征(I-CRS)方面是否优于血清肌酐(SCr)。方法选取急性左心衰竭患者78例,其中CRS组31例,NCRS组47例,30例正常人为对照组。急性左心衰竭患者入院后按0 h、24 h、48 h、72h、168 h时间点收集血清检测SCr、cTnT,收集尿液检测KIM-1。结果CRS组SCr从0 h即高于对照组(P<0.05),从24 h开始高于NCRS组(P<0.05)。CRS组及NCRS组的cTnT从0 h即高于对照组(P<0.05)。CRS组KIM-1从0 h时即高于另外两组(P<0.05)。利用ROC检测SCr诊断Ⅰ-CRS的最佳时间为72 h,AUC为1.000(95%CI 0.000~1.000),cTnT的最佳时间为168 h,AUC为0.826(95%CI 0.791~0.897),KIM-1的最佳时间为24 h,AUC为0.970(95%CI 0.948~0.998)。结论 KIM-1可比SCr更早的反映急性心衰对肾脏的损伤,但cTnT的价值有限。

Objective To investigate whether KIM-1 and cTnT are superior to SCr in diagnosis I-CRS.Methods 78 patients with acute left heart failure were selected,including 31 patients were CRS,and 47 of them were NCRS,and 30 healthy individuals were selected as control group.After acute left heart failure,patients were admitted to the hospital by 0 h,24 h,48 h,72 h,168 h time points to collect serum detection of SCr,cTnT,urine was collected to detect KIM-1.Results The SCr levels of CRS group were higher than control group from 0 h(P<0.05),and higher than NCRS group from 24 h(P<0.05).The levels of cTnT in CRS and NCRS groups were higher than control group from 0 h(P<0.05).The KIM-1 levels in CRS group were higher than control group and NCRS group form 0 h(P<0.05).The optimal time for diagnosis of I-CRS with ROC was 72 h,AUC was 1.000(95%CI 0.000~1.000),and the best time of cTnT was 168 h,and the AUC was 0.826(95%CI 0.791~0.897),and the best time of KIM-1 was 24 h,the AUC was 0.970(95%CI 0.948~0.998).Conclusion KIM-1 can react earlier than SCr to acute damage of kidney function induced by acute heart failure,but value of cTnT is limited.