目的 探究与分析尿中性粒细胞明胶相关性载脂蛋白(NGAL)与肾损伤分子1(KIM-1)联合检测在对比剂肾病早期诊断中的价值.方法 应用前瞻性研究方法收集2017年于航天中心医院行冠脉介入治疗的116例冠心病患者的临床资料,根据其术后是否发生对比剂肾病,将其分为非对比剂肾病组(对照组,n=90)及对比剂肾病组(观察组,n=26).对比两组各节点血清肌酐、血清尿素氮、尿NGAL及KIM-1水平变化情况.结果 从术后2d开始,机体血清肌酐水平显著增加(P＜0.05);观察组术后2d [(102.43±20.31)μmol/L]、术后3d[(107.22±25.13)μmol/L]血清肌酐值明显高于对照组术后2d[(92.89±16.74)μmol/L]、术后3d[(91.97±15.38)μmol/L]血清肌酐值;观察组从术后12h开始,机体血清尿素氮水平显著增加(P＜0.05);观察组术后12h、1、2、3d血清尿素氮值明显高于对照组,差异有统计学意义(P＜0.05);观察组术后4、12h、术后1、2d的尿NGAL值均明显高于对照组;观察组术后1d[(5.14±0.96)μg/L]、术后2d[(5.58±1.33)μg/L]的KIM-1值均明显高于对照组术后1d[(3.58±1.23)μg/L]、术后2d[(3.64±1.15)μg/L]的KIM-1值,差异有统计学意义(P＜0.05).由Pearson相关性分析可知,对比剂肾病术后4h的尿NGAL值与术后2d血清肌酐值呈正相关(r=0.784、P=0.000);与术后1d血清尿素氮值呈正相关(r=0.811、P=0.000).对比剂肾病术后1d的尿KIM-1水平与术后2d血清肌酐值呈正相关(r=0.596,P=0.000);与术后2d血清尿素氮值呈正相关(r=0.644、P=0.000).经ROC曲线分析可知,尿NGAL曲线下面积为0.917(95％的可信区间为:0.884～0.951),灵敏度为86.74％、特异度为93.92％;KIM-1曲线下面积为0.842(95％的可信区间为:0.755～0.901),灵敏度为81.16％,特异度为83.47％.结论 尿NGAL及KIM-1是能较早反应肾功能损伤情况的生化标志物,在对比剂肾病早期诊断中具有肯定的价值意义.%Objective To explore and analyze the effect and value of combined detection of urine neutrophil gelatin-associated apolipoprotein (NGAL) and kidney injury molecule 1 (KIM-1) in the early diagnosis of contrast-induced nephropathy.Methods The clinical data of 116 patients with coronary heart disease who received coronary intervention treatment in our hospital in 2017 were collected with forward-looking research methods.The patients were divided into the non-contrast-induced nephropathy group (control group, n=90) and the contrast-induced nephropathy group (observation group, n=26) according to the occurrence of contrast-induced nephropathy.The levels of serum creatinine, serum urea nitrogen, urine NGAL and KIM-1 were compared at different time points between the two groups.Results From 2 days after surgery, the serum creatinine levels were increased significantly (P＜0.05).The serum creatinine levels at 2 days after surgery (102.43±20.31) μmol/L and 3 days after surgery (107.22±25.13) μmol/L in the observation group were significantly higher than those in the control group[ (92.89±16.74) μmol/L, (91.97±15.38) μmol/L];The serum urea nitrogen levels in the observation group were increased significantly from 12 hafter surgery (P＜0.05);the serum urea nitrogen levels of the observation group at 12 h, 1 d, 2 dand 3 dafter surgery were significantly higher than those of the control group (P＜0.05);The urine NGAL levels at 4 and 12 hour and 1 and 2 days after surgery in the observation group were significantly higher than those in the control group;The KIM-1 levels at 1 day after surgery (5.14±0.96) μg/L and 2 days after surgery (5.58±1.33) μg/L in the observation group were significantly higher than those in the control group [ (3.58±1.23) μg/L, (3.64±1.15) μg/L], and the differences were statistically significant (P＜0.05).Pearson correlation analysis showed that there was a positive correlation between urinary NGAL at 4 hours postoperatively and serum creatinine at2 days postoperatively (r=0.784, P=0.000), and positively correlated with serum urea nitrogen level at 1 day postoperatively (r=0.811, P=0.000).The KIM-1 level at 1 day postoperatively was positively correlated with the serum creatinine level at 2 days postoperatively (r=0.596, P=0.000), and positively correlated with the serum urea nitrogen level at 2 days postoperatively (r=0.644, P=0.000).ROC curve analysis showed that the area under curve (AUC) of urine NGAL was 0.917[95％confidence interval (CI) :0.884-0.951], the sensitivity was 86.74％, and the specificity was 93.92％;AUC of KIM-1 was 0.842 (95％CI:0.755-0.901), the sensitivity was 81.16％, and the specificity was 83.47％.Conclusion Urine NGAL and KIM-1 are biochemical markers that can early react to the impairment of renal function, and have positive value in the early diagnosis of contrast-induced nephropathy.
展开▼
