摘要
目的探讨冠状动脉介入诊疗术后患者尿中性粒细胞明胶酶相关性载脂蛋白（NGAL）和肾损伤分子1（KIM-1）的变化，并评价两者在早期预测对比剂肾病（CIN）中的价值。方法采用前瞻性研究方法收集160例接受冠状动脉造影及介入治疗患者的临床资料。以术后发生CIN的患者作为CIN组（14例），以2：1的比例选取未发生CIN的患者作为非CIN组（28例）。检测两组患者术前和术后24、48、72h血清肌酐水平，术前和术后4、24h尿NGAL和KIM-1水平，分析NGAL、KIM-1与血清肌酐的关系。描绘受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评价尿NGAL和KIM-1诊断CIN的敏感度和特异度。结果（1）术后4h，CIN组尿NGAL水平高于非CIN组（P〈0．01）；CIN组尿NGAL水平高于术前基线水平（P〈0．01）。（2）术后24h，CIN组尿KIM一1水平高于非CIN组（P〈0．01）；CIN组尿KIM．1水平高于术前基线水平（P〈0．01）。（3）Pearson相关分析显示，CIN组患者尿NGAL水平与血清肌酐水平呈正相关（r=0．814，P〈0．01），尿KIM-1水平也与血清肌酐水平呈正相关（r=0．758，P〈0．01）。（4）ROC曲线显示，尿NGAL的曲线下面积为0．897，检测截断点为11．950μg /L时的敏感度和特异度分别为92．9％和71．4％；尿KIM－1曲线下面积为0．839，检测截断点为4．595μg／L时的敏感度和特异度分别为85．7％和71．4％。结论尿NGAL在冠状动脉介入诊疗术中使用对比剂后4h就能提示急性肾损伤，可能为较好的CIN早期生化标志物；尿KIM－1能较血清肌酐更早地反映肾功能的变化，在早期预测CIN中有一定的价值。
Objective To explore the predict value of monitoring changes of urinary neutrophil gelatinase-associated lipocalin （NGAL） and kidney injury molecule-1 （KIM-1） after coronary angiography （CAG） and percutaneous coronary intervention （PCI） on the early diagnosis of contrast-induced nephropathy （CIN）. Methods One hundred and sixty patients underwent CAG and PCI were enrolled in this prospective study. There were 14 patients with CIN and non-CIN patients were selected with the proportion of 2：1 （n =28）. Serum creatinine （SCr） was measured before and at 24, 48 and 72 h after the procedure. Urinary NGAL and KIM-I were measured before and at 4 and 24 h after the procedure. The relationship between NGAL, KIM-1 and CIN were analyzed. Receiver operating characteristic （ROC） curve and area under the ROC curve （AUC） were used to analyze the diagnostic sensitivity and specificity of CIN by urinary NGAL and KIM-1. Results （ 1 ） The values of urinary NGAL was significantly higher in the CIN group than in non-CIN group at 4 h after CAG or PCI （ P 〈 0. 01 ） ; the value of urinary NGAL was significantly increased from the baseline to 4 h after the procedure in the CIN group （P 〈 0. 01 ）. （2） Uurinary KIM-1 levels of CIN group was significantly higher than in non-CIN group at 24 h after the CAG or PCI（P 〈0. 01 ） ; the urinary KIM-1 levels was significantly increased from baseline to 24 h after the procedure in the CIN group（P 〈 0. 01 ）. （3）Pearson correlation analysis showed that there was a positive correlation betweenurinary NGAL and SCr （r =0. 814 ,P 〈0. 01 ） and urinary KIM-1 （r = 0. 758 ,P 〈 0. 01 ） in the CIN group. （4） ROE curve analysis showed that the AUC for urinary NGAL was 0. 897. When the cut-off value of NGAL was set at 11. 950 μg/L, the sensitivity and specificity for the diagnosis of CIN were 92. 9% and 71.4% , respectively. The AUC for urinary KIM-1 was 0. 839. With the cut-off value of urinary KIM-1 set as 4.595 μg/L, the diagnostic sensitivity and specificity for CIN were 85.7% and 71.4%, respectively. Conclusions Urinary NGAL serves as a good biomarker for early diagnosis of CIN suggesting acute kidney injury at 4 h post CAG and PCI. Urinary KIM-1 can reflect the change of renal function after contrast injection earlier than SCr and may also be a good biomarker for early diagnosis of CIN.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2014年第4期301-304,共4页
Chinese Journal of Cardiology
关键词
肾病
造影剂
预测
Nephrosis
Contrast media
Forecasting
