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

Abstract

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

CLC Number:

R 692

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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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

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