老年心脏手术后并发急性肾损伤病人尿液NGAL、KIM-1、IL-18、NAG水平变化及意义

doi:10.3969/j.issn.1003-9198.2021.08.005

摘要/Abstract

摘要： 目的分析老年心脏手术后并发急性肾损伤(AKI)病人尿液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)、IL-18、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)的水平及意义。方法选取2020年3~7月本院接受心脏手术的老年病人60例,依据术后是否发生AKI分为非AKI组和AKI组,检测并比较2组手术前后尿液NGAL、KIM-1、IL-18、NAG、尿量及血清肌酐(Scr)、BUN水平,分析NGAL、KIM-1、IL-18、NAG与Scr、BUN的相关性;比较AKI组中不同转归(28 d存活或死亡)病人尿液NGAL、KIM-1、IL-18、NAG水平;绘制ROC曲线分析尿液NGAL、KIM-1、IL-18、NAG对AKI的预测价值。结果 2组术后尿液NGAL、KIM-1、IL-18、NAG水平及血BUN、Scr水平均较术前明显升高,且AKI组升高更明显,差异均有统计学意义(P＜0.05);术后2组尿量均较术前升高,AKI组术后24、48 h尿量明显低于非AKI组(P＜0.05)。AKI病人术后48 h内尿液NGAL、KIM-1、IL-18、NAG水平均与BUN水平呈正相关,NGAL、KIM-1水平与Scr水平呈正相关(P＜0.05)。术后28 d,死亡组术后48 h NGAL、KIM-1、IL-18、NAG水平均高于存活组(P＜0.05);ROC曲线分析显示,NGAL、KIM-1、IL-18、NAG联合检测预测AKI的敏感度、特异度、AUC高于各指标单独预测。结论老年心脏手术病人术后容易并发AKI,监测尿液NGAL、KIM-1、IL-18、NAG水平对AKI的早期诊断及病人预后判断有重要意义。

关键词: 老年人, 心脏手术, 急性肾损伤, 中性粒细胞明胶酶相关脂质运载蛋白, 肾损伤分子1, 白细胞介素-18, N-乙酰-β-D-氨基葡萄糖苷酶

Abstract: Objective To analyze the changes and significance of urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin-18 (IL-18) and N-acetyl-β-D-glucosaminidase (NAG) in the elderly patients complicated with acute kidney injury (AKI) after cardiac surgery. Methods A total of 60 elderly patients who underwent cardiac surgery in our hospital from March 2020 to July 2020 were enrolled. According to presence or absence of AKI, the patients were divided into non-AKI group and AKI group. The changes of the urine levels of NGAL, KIM-1, IL-18 and NAG, the serum levels of creatinine (Scr) and blood urea nitrogen (BUN),and the urine volume before and after the operation were detected and compared between the two groups. The correlation between urine NGAL, KIM-1, IL-18, NAG and Scr, BUN were analyzed. The urine levels of NGAL, KIM-1, IL-18 and NAG were compared in patients with different outcomes (survival or death within 28 d) in AKI group. The predictive value of urine NGAL, KIM-1, IL-18 and NAG for AKI was analyzed by drawing ROC curves. Results The urine levels of NGAL, KIM-1, IL-18 and NAG in the two groups after the surgery were significantly higher than those before the surgery in both groups, especially in the AKI group (P<0.05).After the operation, the urine volume in both groups was increased, but the urine volume in the AKI group was significantly lower than that in non-AKI group 24,48 h after the operation (P<0.05). The correlation analysis showed that the urine levels of NGAL, KIM-1, IL-18 and NAG were positively correlated with BUN within 48 h after surgery, and the urime levels of NGAL and KIM-1 were positively correlated with Scr in the AKI patients (P<0.05). At 28 d after surgery, the urime levels of NGAL, KIM-1, IL-18 and NAG within 48 h after surgery in the death group were significantly higher than those in the survival group (P<0.05). ROC curve analysis showed that sensitivity, specificity and area under the curve (AUC) of NGAL combined with KIM-1, IL-18 and NAG for predicting AKI were all higher than those of single index. Conclusions The elderly patients are prone to AKI after cardiac surgery. Monitoring urine levels of NGAL, KIM-1, IL-18 and NAG is of great significance for early diagnosis and prognostic judgement of AKI.

Key words: aged, cardiac surgery, acute kidney injury, neutrophil gelatinase-associated lipocalin, kidney injury molecule 1, interleukin-18, N-acetyl-β-D-glucosaminidase

中图分类号:

R 692

谭丹, 彭伟, 吴方昊, 赵亮, 张国彬, 杨波, 霍文谦. 老年心脏手术后并发急性肾损伤病人尿液NGAL、KIM-1、IL-18、NAG水平变化及意义[J]. 实用老年医学, 2021, 35(8): 807-811.

TAN Dan, PENG Wei, WU Fang-hao, ZHAO Liang, ZHANG Guo-bin, YANG Bo, HUO Wen-qian. Changes and significance of urine levels of NGAL, KIM-1, IL-18 and NAG in elderly patients complicated with acute kidney injury after cardiac surgery[J]. Practical Geriatrics, 2021, 35(8): 807-811.

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