中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子1和白介素18在诊断心肺分流术后急性肾损伤中的意义

摘要

Objective To investigate the values of urine neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecular-1 (KIM-1) and interleukin-18 (IL-18) in the diagnosis of acute kidney injury (AKI) in children after cardiopulmonary by-pass (CPB). Methods Sixty-seven patients who had undergone CPB were recruited from March to June 2013 and assigned to acute kidney injury group (AKI group) or non-acute kidney injury group (non-AKI group) according to the pediatric RIFLE (pRIFLE) cri-teria. Serum and urine samples were collected from each patient at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h after CPB for serum and urine creatinine, urine NGAL, KIM-1 and IL-18. All the data were evaluated by receiver operator characteristic curve (ROC) analysis and area under curve (AUC) analysis. Results Twenty-three cases (34.3%) had AKI in 67 children after CPB. Among them 15 cases were risk-stage AKI, 4 cases injury-stage AKI, 3 cases failure-stage AKI and 1 cases loss-stage AKI. The levels of urine NGAL/Ucr were higher in AKI group than those in non-AKI group at 4h, 48h and 72h after CPB (P<0.05). The cut-off value of NGAL/Ucr was 1.200 at 4 h after CPB, the sensitivity and specificity for prediction of AKI were 0.864 and 0.561, and the AUC was 0.671 (95%CI:0.537-0.804). The levels of urine KIM-1/Ucr were higher in AKI group than those in non-AKI group at 48h and 72 h after CPB (P<0.05). The cut-off value of KIM-1/Ucr was 1.162 at 24h after CPB, the sensitivity and specificity for prediction of AKI were 0.773 and 0.512, and the AUC was 0.698 (95%CI:0.563-0.834). The levels of IL-18/Ucr were higher in AKI group than those in non-AKI group at 4 h after CPB (P<0.05). The cut-off value of IL-18/Ucr was 0.04 at 4 h after CPB, the sensitivity and specificity for predici-ton of AKI were 0.773 and 0.561, and the AUC was 0.655 (95%CI:0.510-0.800). Conclusions It is indicated that urine NGAL, KIM-1 and IL-18 may have important clinical values for early prediction of AKI.%目的：探讨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）和白介素18（IL-18）在儿童心肺分流术（CPB）后急性肾损伤（AKI）临床诊断中的价值。方法随机收集2013年3月至2013年6月住院行CPB的先天性心脏病患儿67例，按照pRIFLE标准分为AKI组及非AKI组；观察术前，术后30 min、2 h、4 h、24 h、48 h和72 h血清肌酐（Scr）、尿NGAL、尿KIM-1、尿肌酐（Ucr）及尿IL-18水平。采用受试者工作特征曲线（ROC）及曲线下面积（AUC）评价NGAL、KIM-1及IL-18早期预测AKI的价值。结果67例CPB儿童中23例（34.3%）发生AKI。按pRIFLE标准分期：危险期15例，损伤期4例，衰竭期3例，丧失期1例。AKI组术后4 h、48 h和72 h尿NGAL/Ucr高于非AKI组，差异有统计学意义（P<0.05）；术后4 h尿NGAL/Ucr为1.20时，预测AKI的灵敏度和特异度为0.864和0.561，AUC为0.671（95%CI：0.537~0.804）。术后48 h和72 h AKI组尿KIM-1/Ucr高于非AKI组，差异有统计学意义（P<0.05）；CPB术后24 h尿KIM-1/Ucr为1.16时，预测AKI的灵敏度和特异度分别为0.773和0.512，AUC为0.698（95%CI：0.563~0.834）。术后4 h AKI组尿IL-18/Ucr高于非AKI组，差异有统计学意义（P<0.05）；CPB术后4 h尿IL-18/Ucr为0.04时，预测AKI的灵敏度和特异度为0.773和0.561，AUC为0.655（95%CI：0.510~0.800）。结论联合检测尿NGAL、尿KIM-1及尿IL-18水平对儿童CPB术后早期预测AKI的发生可能具有重要的临床价值。