尿肾损伤分子-1在早期对比剂肾病诊断中的意义

摘要

目的：探讨尿肾损伤分子-1（KIM-1）在对比剂肾病（CIN）早期诊断中的应用意义。方法选取2013年1月-2014年1月在首都医科大学附属北京世纪坛医院心内科接受冠状动脉介入术的住院患者80例，根据有无CIN发生，将患者分为CIN组和无CIN组。对患者进行迈赫兰（ Mehran）积分评分，按照积分的不同将患者进行分组：≤5分组，6~10分组，11~16分组，>16分组。收集患者术前血液、尿液以及术后6、12、24、48、72 h尿液和24、48、72 h血液，采用酶联免疫吸附测定（ ELISA）法检测尿液中KIM-1、α1微球蛋白的水平，采用酶法检测血肌酐（Scr）水平。结果80例患者中6例（7.5%）发生CIN。经Mehran积分分析，积分≤5分组中发生0例；6~10分组中发生2例；11~16分组中发生2例；>16分组中发生2例，其中1例需行血液透析治疗。不同积分组CIN发生率比较，差异有统计学意义（ P<0.05）。无CIN组和CIN组患者尿KIM-1、α1微球蛋白水平在术前及术后6、12、24、48、72 h比较，差异有统计学意义（ P<0.05）。组间比较：术后12、24、48、72 h CIN组尿KIM-1水平高于无CIN组（P<0.05）；术后24、48、72 h CIN组α1微球蛋白水平高于无CIN组（P<0.05）。组内比较：CIN组尿KIM-1水平在术后12、24、48、72 h高于术前及术后6 h（P<0.05）；CIN组α1微球蛋白在术后24、48、72 h高于术前及术后6、12 h（P<0.05）。男、女性两组患者Scr水平在术前、术后24、48、72 h比较，差异有统计学意义（P<0.05）。男、女性CIN组术后48、72 h Scr水平均高于无CIN组（P<0.05）。男、女性CIN组术后48、72 h Scr水平均高于术前及术后24 h（P<0.05）。将CIN组患者术后12 h测出的尿KIM-1最大值与术后48 h测出的Scr最大值进行Pearson相关性分析显示，两者呈正相关（ r=0.821，P=0.045）。结论术后12 h尿KIM-1水平升高，术后24 h尿α1微球蛋白水平升高，术后48 h Scr升高。与传统的肾脏损伤指标相比，尿KIM-1可以更早期预测CIN的发生。%Objective To discuss the significance of the Kidney Injury Molecule-1 ( KIM-1 )in early diagnosis of contrast induced nephropathy( CIN). Methods Eighty patients who had coronary intervention in Department of Cardiology of Beijing Shijitan Hospital from January 2013 to January 2014 were divided into groups CIN,non-CIN. And the patients were scored by Mehran Scales and divided,according to the scores,into subgroups≤5,6-10,11-16,>16. Collecting blood, urine before operation,urine at hours 6,12,24,48,72 after operation,blood at hours 24,48,72 after operation and de-tected the levels of urine KIM -1 ,α1 -microglobulin by enzyme -linked immunosorbent assay ( ELIS ), serum creatinine (Scr)level by enzymic method. Results In 80 patients,6 had CIN(7. 5%). By Mehran scale analysis,0 patient had CIN in≤5 subgroup,2 in 6-10 subgroup,2 in 11-16 subgroup,2 in>16 subgroup including 1 who needed hemodialysis. There was significant difference in CIN incidence in different subgroups(P<0. 05). CIN group was different from non-CIN group in KIM-1,α1 -microglobulin before operation and at hours 6,12,24,48,72(P<0. 05). In group comparison:KIM-1 level was higher in CIN group than in non-CIN group at hours 12,24,48,72 after operation(P<0. 05),and α1 -micro-globulin level higher at hours 24,48,72 after operation(P<0. 05). In intra-group comparison:in CIN group,KIM-1 level was higher at hours 12,24,48,72 after operation than before operation and at hours 6 after operation(P<0. 05),α1 -microglobulin higher at hours 24,48,72 after operation than before operation and at hours 6,12(P <0. 05). There was difference in Scr level between males and females before operation,at hours 24,48,72 after operation(P<0. 05). Scr level was higher in males,females of CIN group than in those of non-CIN group at hours 48,72 after operation(P<0. 05). Scr level was higher at hours 48,72 after operation than before operation and at hours 24 in males,females of CIN group( P <0. 05). By Pearson correlation analysis,the maximum value of urine KIM-1 measured at hours 12 after operation were positive-ly correlated with that of Scr level measured at hours 48(r=0. 821,P=0. 045). Conclusion The level of urine KIM-1 in-creased at hours after operation,α1 -microglobulin rose at hours 24,Scr elevated at hours 48. Urine KIM-1 can predict CIN early as compared with traditional indicators of kidney damages.