尿中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子-1在泌尿系统疾病患儿应用造影剂后的变化及干预效果评价

Urinary neutrophil gelatinase-associated lipocalin and kidney injury molecule 1 measurements in children with urinary system diseases after contrast media administration and the evaluation of hydration therapy

目的研究尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、肾损伤分子-1(kidney injury molecule 1,KIM-1)在儿童应用造影剂前后的动态变化及给予水化治疗后的干预效果评价。方法收集2012年3月至2014年3月于中国医科大学附属盛京医院小儿肾内科、小儿泌尿外科行静脉肾盂造影(intravenous pyelography,IVP)检查的泌尿系统疾病患儿共58例,随机分为水化组28例,未水化组30例,同期呼吸系统疾病行肺部增强CT检查无泌尿系统疾病并且无水化干预患儿共24例做为对照,采用ELISA法检测在静脉注射造影剂0 h、24 h、48 h、72 h、96 h各时间点尿中NGAL、KIM-1水平,以及0 h、48 h、96 h各时间点血清肌酐(serum creatinine,Scr)变化特征。结果本研究共82例研究对象中,泌尿系统疾病行IVP检查患儿58例,呼吸系统疾病行增强CT检查患儿24例,均未发生造影剂导致急性肾损伤。58例泌尿系统疾病行IVP患儿中,未水化组尿NGAL造影后24 h、48 h比造影前升高,水化组尿NGAL造影后48 h、72 h比造影前升高,但水化组在24 h、48 h尿NGAL低于未水化组,差异均有统计学意义(P<0.05)。未水化组尿KIM-1在造影后24 h、48 h、72 h比造影前升高,水化组尿KIM-1造影后48 h、72 h比造影前升高,但水化组尿KIM-1在24 h、48 h、72 h低于未水化组,差异均有统计学意义(P<0.05)。行增强CT患儿使用造影剂前后各时间点尿NGAL及尿KIM-1比较,差异无统计学意义(P>0.05)。结论存在泌尿系统疾病患儿在使用造影剂后会发生尿NGAL及尿KIM-1升高,有自行恢复趋势,水化干预可减轻这种升高的趋势。对于无泌尿系统疾病行增强CT检查患儿,未观察到尿NGAL及尿KIM-1的升高。

Objective To investigate the dynamic changes of neutrophil gelatinase-associated lipocalin(NGAL) and kidney injury molecule 1(KIM-1) in children after contrast media administration and evaluate the effect of hydration therapy. Methods A total of 58 patients with urinary system diseases who were admitted to Shengjing Hospital of China Medical University from March 2012 to March 2014 for intravenous pyelography(IVP) in pediatric department were enrolled.The 58 patients were randomly divided into hydration group of 28 patients and non-hydration group of 30 patients.Contemporaneous 24 patients received respiratory system enhanced CT examination without urinary tract diseases and hydration were enrolled as control group.Urine NGAL and KIM-1 of the three groups at 0 h, 24 h, 48 h, 72 h, 96 h after using intravenous contrast media were detected by ELISA.Serum creatinine of the three groups at 0 h, 48 h, 96 h after using intravenous contrast media were detected. Results All of the 82 subjects in this study didn′t occur contrast-induced acute kidney injury.The urinary NGAL of non-hydrated group significantly increased at 24 h and 48 h after contrast media administration(P<0.05) and the urinary NGAL of hydrated group significantly increased at 48 h and 72 h(P<0.05). But the urinary NGAL at 24 h and 48 h of the hydration group were lower than these of the non-hydrated group, there were statistically significant differences(P<0.05). At 24 h, 48 h and 72 h after contrast media administration, the level of urine KIM-1 in the non-hydration group significantly increased(P<0.05). Urine KIM-1 at 48 h and 72 h in the hydration group significantly increased(P<0.05). But the urine KIM-1 at 24 h, 48 h and 72 h of the hydration group were lower than these of the non-hydration group, the differences were statistically significant(P<0.05). Comparison of urine NGAL and KIM-1 at different times before and after contrast media administration in children receiving enhanced CT examination who without urinary tract disease showed no statistically significant differences(P>0.05). Conclusion The urine NGAL and KIM-1 of children with urinary system diseases increase after contrast media administration and there is a trend of spontaneous recovery.Hydration intervention can alleviate the upward trend of urine NGAL and KIM-1.For children receiving enhanced CT examination but without urinary system diseases, the change of urine NGAL and KIM-1 are not significant.