先天性心脏病患儿术后检测尿NGAL、KIM-1对预测急性肾损伤的意义探讨

摘要

Objective To investigate the significance of urine neutrophil gelatinase associated lipocalin (NGAL ) and renal injury molecule-1 (KIM-1) in predicting the acute kidney injury (AKI) in children with congenital heart disease after operation .Methods From April 2014 to December 2015 ,67 cases of cardiopulmonary bypass in children with congenital heart disease were studied in our hospital ,all patients were divided into AKI group (n=24) and non AKI group (n=43) by pRIFLE standard .Serum creatinine , urine NGAL and urine KIM-1 levels were compared between the two groups before and after the operation ,the receiver operating characteristic curve (ROC curve) and the area under the curve (AUC) were used to evaluate the value of NGAL and KIM-1 in pre-dicting the postoperative AKI in children with congenital heart disease .Results There was no significant difference between the two groups in preoperative and postoperative 2 h and 4 h creatinine (P>0 .05) ,but the levels of postoperative 12 ,24 ,48 h creati-nine in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The NGAL level of postoperative 2 ,4 , 6 ,12 h in non AKI group was significantly lower than that in AKI group (P<0 .05) ,but there was no significant difference in the level of postoperative 24 h urine NGAL between the two groups (P>0 .05) .There was no significant difference between the two groups of patients with postoperative 2 h urinary KIM-1 (P>0 .05) ,postoperative 4 ,6 ,12 ,24 h urinary KIM-1 levels in the non AKI group were significantly lower than those in the AKI group (P<0 .05) .The optimal time point separate detection of urinary NGAL levels to assist in diagnosis of AKI after 12 h ,AUC was 0 .834 (95% CI:0 .631-0 .912);the best time point separately to detect the level of KIM-1 AKI to assist in the diagnosis of AKI after 24 h ,AUC was 0 .871 (95% CI:0 .665-0 .933);combined de-tection of urinary NGAL and KIM-1 levels to assist the best time for the diagnosis of AKI after 24 h ,AUC was 0 .913(95% CI:0 .745-0 .968) .Conclusion Urine NGAL and urine KIM-1 in children with congenital heart disease after operation have important clinical significance in predicting the occurrence of AKI .%目的 探讨先天性心脏病患儿术后检测尿液中性粒细胞明胶酶相关性载脂蛋白(NGAL)及肾损伤分子1(KIM-1)对预测急性肾损伤(A K I)的意义.方法 选取2014年4月至2015年12月67例在该院进行心肺分流术的先天性心脏病患儿作为研究对象,依据pRIFLE标准分为AKI组(n=24)及非AKI组(n=43).比较两组患儿手术前后血清肌酐、尿NGAL及尿KIM-1水平,并采用受试者工作特征曲线(ROC曲线)及ROC曲线下面积(AUC)评价NGAL及KIM-1预测小儿先天性心脏病术后AKI的价值.结果 两组患儿术前,术后2、4 h肌酐比较,差异无统计学意义(P>0.05);但非A K I组患儿术后12、24、48 h肌酐水平比较,明显低于AKI组(P<0.05).非AKI组患儿术后2、4、6、12 h尿NGAL水平明显低于AKI组(P<0.05),而两组患儿术后24 h尿NGAL水平检测,差异无统计学意义(P>0.05).两组患儿术后2 h尿KIM-1水平比较,差异无统计学意义(P>0.05),非AKI组患儿术后4、6、12、24 h尿KIM-1水平明显低于AKI组(P<0.05).单独检测尿NGAL水平协助诊断AKI的最佳时间点为术后12 h,A U C为0.834(95%C I:0.631~0.912);单独检测K IM-1水平协助诊断A K I的最佳时间点为术后24 h,A U C为0.871(95%CI:0.665~0.933);联合检测尿NGAL及KIM-1水平协助诊断AKI的最佳时间点为术后24 h,AUC为0.913(95%CI:0.745~0.968).结论 小儿先天性心脏病术后检查尿NGAL及KIM-1水平对预测AKI的发生具有重要临床意义.