NGAL、Cys C在瓣膜病换瓣术后早期诊断急性肾损伤的意义

Clinical significance of NGAL and Cys C in early diagnosis of acute kidney injury after valvular disease operation

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)和胱抑素C(cystatin C,Cys C)在瓣膜病换瓣术后并发急性肾损伤(acute kidney injury,AKI)的临床意义。方法选取瓣膜病术后患者90例,根据是否发生AKI分为AKI组(37例)及非AKI组(53例)。于术前和术后2,4,6,8,12,24,48 h收集血标本,采用酶联免疫吸附测定法检测血清NGAL浓度,采用肌氨酸氧化酶法测定血肌酐(serum creatinine,SCr)水平,采用免疫投射比浊法测定血清Cys C水平。结果2组SCr水平均呈先升高再降低趋势,AKI组SCr水平变化幅度大于非AKI组,AKI组SCr术后12 h明显升高,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。AKI组血NGAL水平均呈先升高再降低趋势,非AKI组血NGAL水平逐渐降低,AKI组血NGAL水平高于非AKI组,AKI组血清NGAL术后2 h明显升高,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。2组血Cys C水平均呈逐渐升高趋势,AKI组血Cys C水平变化幅度大于非AKI组,AKI组术后6 h明显升高,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。结论AKI组瓣膜病换瓣术后2 h血清NGAL浓度明显升高,术后6 h血清Cys C水平开始升高,两者水平升高的时间均早于SCr。血清NGAL和Cys C可作为瓣膜病术后诊断AKI的早期标志物。

Objective To assess the clinical significance of neutrophil gelatinase-associated lipocalin(NGAL)and cystatin C(Cys C)for acute kidney injury(AKI)after valvular disease operation.Methods Ninety patients with valvular disease after surgery were selected and divided into AKI group(37 cases)and non-AKI group(53 cases)according to the occurrence of AKI.Blood samples were collected before surgery and 2,4,6,8,12,24,48 hours after surgery.The serum NGAL level was determined by enzyme-linked immunosorbent assay.The serum creatinine(SCr)levels were determined by creatinine sarcosine oxidase method.The serum Cys C levels were determined by immune projection turbidimetry.Results SCr levels in both groups increased first and then decreased.The change of SCr level in AKI group was larger than that in non-AKI group.SCr in AKI group increased significantly at 12h after surgery.There were statistically significant differences between two groups,time points and their interaction(P<0.05).Serum NGAL level in the AKI group increased first and then decreased,while serum NGAL level in the non-AKI group decreased gradually.Serum NGAL level in the AKI group was higher than that in the non-AKI group.Serum NGAL level in the AKI group increased significantly at 2h after surgery.There were statistically significant differences between groups,time points and their interaction(P<0.05).The level of blood Cys C increased gradually in twe groups.The variation amplitude of serum Cys C level in AKI group was greater than that in non-AKI group.Serum Cys C level in the AKI group increased significantly at 6h after surgery.There were statistically significant differences between groups,time points and their interaction(P<0.05).Conclusion Serum NGAL concentration of the AKI group increased significantly at 2 h after valvular disease replacement.Serum Cys C level of the AKI group began to increase at 6 h after surgery.The increase time of both was earlier than the increase time of SCr level.Serum NGAL and serum Cys C can be used as markers for the early diagnosis of AKI after valvular disease operation.