先天性心脏病患儿术后急性肾损伤的影响因素及尿NGAL、KIM-1的诊断价值分析

The Influencing Factors of Postoperative Acute Kidney Injury in Children with Congenital Heart Disease and the Diagnostic Value of Urinary NGAL and KIM-1

目的:探讨影响先天性心脏病患儿术后急性肾损伤(AKI)的影响因素及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)的诊断价值。方法:选择2018年1月至2019年12月我院心胸外科收治的60例先天性心脏病术后并发AKI患儿(AKI组)和同期收治的172例先天性心脏病术后未发生AKI患儿(NAKI组)作为研究对象。收集患儿临床基线资料,检测尿NGAL、KIM-1水平,采用Logistic回归分析先天性心脏病患儿术后发生AKI的影响因素,受试者工作特征曲线(ROC)分析尿NGAL、KIM-1诊断先天性心脏病患儿术后发生AKI的价值。结果:AKI组年龄、体重低于NAKI组(P<0.05),手术时间、心肺转流(CPB)时间、主动脉阻断(ACT)时间、机械通气时间、重症监护室(ICU)住院时间长于NAKI组(P<0.05),术后平均动脉压(MAP)、尿素氮(BUN)、血肌酐(Scr)、NGAL、KIM-1高于NAKI组(P<0.05)。Logistic回归分析结果显示低龄、低体重、CPB时间长、高NGAL、KIM-1水平是先天性心脏病患儿术后发生AKI的危险因素(P<0.05)。ROC分析显示尿NGAL、KIM-1诊断先天性心脏病患儿术后发生AKI的灵敏度分别为81.67%,83.33%,特异度分别为84.30%,87.79%。结论:低龄、低体重、CPB时间长、高NGAL、KIM-1水平是先天性心脏病患儿术后发生AKI的危险因素,尿NGAL、KIM-1诊断先天性心脏病术后AKI具有较高价值。

Objective:To investigate the influencing factors of postoperative acute kidney injury(AKI)in children with congenital heart disease and the diagnostic value of urinary neutrophil gelatinase-associated lipocalin(NGAL)and kidney injury molecule 1(KIM-1).Methods:From January 2018 to December 2019,60 children with congenital heart disease postoperative with AKI(AKI group)and 172 children with congenital heart disease postoperative without AKI(NAKI group)who were admitted to the cardiac surgery department of our hospital were selected as the research objects.The clinical baseline data of the children were collected,urine NGAL and KIM-1 levels were detected,and the influencing factors of postoperative AKI in children with congenital heart disease were analyzed by Logistic regression.The receiver operating characteristic curve(ROC)was used to analyze the value of urinary NGAL and KIM-1 in diagnosing postoperative AKI in children with congenital heart disease.Results:Age,body weight in AKI group were below than those of NAKI group(P<0.05),operation time,cardiopulmonary bypass(CPB)time,aortic clamping time(ACT),mechanical ventilation time and intensive care unit(ICU)length of hospital stay time were longer than those of NAKI group(P<0.05),postoperative mean arterial pressure(MAP),urea nitrogen(BUN),serum creatinine(Scr),NGAL,KIM-1 were higher than those of NAKI group(P<0.05).Logistic regression analysis showed that low age,low body weight,long CPB time,high NGAL and KIM-1 levels were risk factors for postoperative AKI in children with congenital heart disease(P<0.05).ROC analysis showed that the sensitivity of urine NGAL,KIM-1 diagnosis of postoperative AKI in children with congenital heart disease were 81.67%,83.33%,the specificity were 84.30%,87.79%.Conclusion:Low age,low body weight,long CPB time,high NGAL and KIM-1 levels are risk factors for postoperative AKI in children with congenital heart disease.Urine NGAL and KIM-1 have high value in diagnosing AKI after congenital heart disease.