肾损伤分子-1在心脏体外循环术后急性肾损伤早期诊断中的应用

摘要

目的:探讨尿肾损伤分子-1(Kim-1)在体外循环术后急性肾损伤(AKI)早期诊断中的应用.方法:收集2010年5-11月无锡人民医院心外科心脏体外循环术后符合入组标准的84例患者.分别检测术前及术后各时间点的尿Kim-1及血肌酐(Scr)水平,根据AKI诊断标准将其分为AKI组及非AKI组进行分析.结果:AKI组Scr升高峰值出现在12～48 h,而尿Kim-1水平从术后2 h起便显著升高,且术后6 h后各时间点的尿Kim-1水平都显著高于非AKI组.经尿肌酐(Ucr)校正后,相应时间点的尿Kim-1/Ucr差异仍有显著性(P<0.01).术后2 h尿Kim-1和尿Kim-1/Ucr的界点值分别在300 ng/L和2.0 ng/mg时,诊断AKI有较好的敏感性和特异性.结论:术后2 h尿Kim-1、尿Kim-1/Ucr可作为体外循环心脏术后AKI发生的早期诊断参考指标.%Objective To evaluate the value of urine kidney injury molecule-1 (Kim-1) in the early diagnosis of acute kidney injury (AKI) after cardiopulmonary bypass (CPB). Methods Data from 84 patients underwent CPB at Wuxi people's Hospital from May to November 2010 were prospectively investigated. The urine levels of Kim-1 and serum levels of creatinine at different time points were measured. All the patients were divided into AKI group and non-AKI group according to the diagnostic standard of AKI. Results The serum level of creatinine reached peak at 12 ~ 48 h in AKI group, and the urine levels of Kim-1 were increased at 2 h after CPB and later, which was significantly higher than those in non-AKI group at 6 h after CPB and later. After corrected by urine creatintine (Ucr), the ratios of Kim-1/Ucr at corresponding time points were still significantly different between the two groups. For the cutoff value of 300 ng/L of urine level of Kim-1 at 2 h after CPB, the sensitivity was 0.786 and the specificity was 0.821, while for that of 2.0 ng/mg of the ratio of Kim-1/Ucr, those were 0.907 and 0.857 respectively. Conclusion The level of Kim-1 and ratio of Kim-1/Ucr in urine at 2 h after CPB could be used as the early diagnostic predictors of AKI.