肾阻力指数联合血液和尿液生物标志物早期预测介入术后造影剂诱导的急性肾损伤的价值

Values of renal resistance index combined with blood and urinary biomarkers in early prediction of contrast⁃induced acute kidney injury after interventional surgery

目的分析肾阻力指数(RRI)、胱抑素C(CysC)、血β2微球蛋白(β2-MG)及尿N-乙酰-β-氨基葡萄糖苷酶(NAG)等指标早期预测造影剂诱导的急性肾损伤(CI-AKI)的价值。方法回顾性队列分析207例介入术后患者,根据是否发生CI-AKI将其分为AKI组(18例)及非AKI组(189例),收集其一般资料和临床资料并比较;再根据诊断AKI的时间[手术当天(D0)或术后第1天(D1)]将AKI组分为AKI(D0)组和AKI(D1)组,比较两组间RRI、CysC、血β2-MG、血肌酐(sCr)及尿NAG等指标。采用logistic回归分析探讨CI-AKI的危险因素。结果AKI组男性、术前sCr、急性生理与慢性健康(APACHⅡ)评分及序贯器官衰竭(SOFA)评分、手术时间、手术当天及术后第1天的sCr、CysC、血β2-MG、尿NAG及RRI等指标均高于非AKI组;高APACHEⅡ评分、高SOFA评分和D1的高CysC是CI-AKI的独立危险因素(P<0.05)。AKI(D0)组的D0 CysC及D0尿NAG均高于AKI(D1)组(P<0.05)。RRI、尿NAG及血β2-MG不是CI-AKI的独立危险因素。结论CysC及尿NAG是CI-AKI诊断强有力的预测因子,而RRI及血β2-MG不能早期预测CI-AKI的发生。

Objective To analyze the values of renal resistance index(RRI),cystatin C(CysC),bloodβ2⁃microglobulin(β2⁃MG)and urinary N⁃acetyl⁃β⁃glucosamine glycosidase(NAG)in early prediction of contrast⁃induced acute kidney injury(CI⁃AKI).Methods A retrospective cohort analysis on 207 postoperative patients after intervention therapy was conducted.The patients were divided into AKI group(18 patients)and non⁃AKI group(189 patients)based on whether CI⁃AKI occurred.General and clinical data were collected and compared.Accord⁃ing to the time of diagnosis of AKI(D0 on the day of surgery or D1 on the first day after surgery),the AKI group was divided into AKI(D0)group and AKI(D1)group.Indicators RRI,CysC,and bloodβ2⁃MG,serum creatinine(sCr),and urinary NAG were compared between the two groups.The risk factors of CI⁃AKI were explored using logistic regression and linear regression.Results In the AKI group,males,preoperative sCr,acute physiological and chronic health(APACHⅡ)score and sequential organ failure(SOFA)score,surgical duratrion,sCr,CysC,bloodβ2⁃MG,urinary NAG on the day of surgery and the first day after surgery,and RRI were higher than those in the non⁃AKI group;Higher APACHEⅡand SOFA scores and higher CysC level on D1 were independent risk factors for the occurrence of CI⁃AKI(P<0.05).Levels of CysC and urinay NAG on D0 were higher in the AKI(D0)group than in the AKI(D1)group(P<0.05).RRI,urinary NAG and bloodβ2⁃MG were not independent risk factors for CI⁃AKI.Conclusions CysC and urinary NAG are powerful predictors for the prediction of CI⁃AKI,and RRI and bloodβ2⁃MG cannot predict the occurrence of CI⁃AKI early.