【摘要】：目的探討尿肝型脂肪酸結(jié)合蛋白(L-FABP)與尿中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白(NGAL)聯(lián)合應(yīng)用在兒童心臟術(shù)后急性腎損傷(AKI)早期診斷中的價值。方法以需建立體外循環(huán)(CPB)的97例先天性心臟病兒童為研究對象,收集其心臟手術(shù)前及術(shù)后不同時間點的血尿標(biāo)本,分別測定血清肌酐(Scr)、尿L-FABP和尿NGAL水平,并比較AKI組(n=18)和非AKI組(n=79)患兒術(shù)后各標(biāo)志物的動態(tài)變化。應(yīng)用受試者工作特征(ROC)曲線及曲線下面積(AUC)評估標(biāo)志物單獨及其聯(lián)合應(yīng)用在預(yù)測術(shù)后AKI發(fā)生中的作用。結(jié)果 AKI組患兒尿L-FABP和尿NGAL水平在術(shù)后2 h、6 h均顯著高于非AKI組,其濃度變化明顯早于Scr的升高。尿L-FABP在術(shù)后2 h、6 h單獨預(yù)測AKI發(fā)生的AUC分別為0.921和0.896;尿NGAL在術(shù)后2 h、6 h單獨預(yù)測AKI發(fā)生的AUC分別為0.908和0.928。術(shù)后2 h及6 h尿L-FABP及NGAL聯(lián)合應(yīng)用預(yù)測術(shù)后AKI發(fā)生的AUC分別為0.942和0.929。結(jié)論尿L-FABP和尿NGAL在兒童心臟術(shù)后AKI早期即顯著升高,明顯早于Scr的改變,可早期預(yù)測AKI的發(fā)生,而兩者聯(lián)合應(yīng)用可使診斷的精確性進(jìn)一步提高。
[Abstract]:Objective to investigate the value of urinary hepatic fatty acid binding protein (L-FABP) combined with urinary neutrophil gelatinase-associated lipid carrier protein (NGAL) in early diagnosis of acute renal injury in children after cardiac surgery. Methods 97 children with congenital heart disease who needed to establish cardiopulmonary bypass (CPB) were studied. Serum creatinine (Scr), urine L-FABP and urinary NGAL were measured before and after cardiopulmonary bypass (CPB). The dynamic changes of markers in AKI group (nm18) and non-AKI group (nm79) were compared. (ROC) curve and area under the curve were used to evaluate the role of markers alone and combined in predicting the occurrence of postoperative AKI. Results the levels of urinary L-FABP and urinary NGAL in AKI group were significantly higher than those in non-AKI group at 2 h and 6 h after operation, and the change of urinary L-FABP and NGAL was earlier than that of Scr. The AUC of urine L-FABP was 0.921 and 0.896 respectively, and the AUC of urine NGAL was 0.908 and 0.928 respectively at 2 hours and 6 hours after operation. The combined use of urinary L-FABP and NGAL at 2 h and 6 h postoperatively predicted the incidence of AKI in 0.942 and 0.929 respectively. Conclusion urinary L-FABP and urinary NGAL increased significantly at the early stage of AKI after cardiac surgery in children, which was significantly earlier than that of Scr, which could predict the occurrence of AKI in the early stage, and the accuracy of diagnosis could be further improved by combined use of the two methods.
【作者單位】： 中南大學(xué)湘雅醫(yī)院腎內(nèi)科;
【基金】：國家自然科學(xué)基金資助(81500559)
【分類號】：R726.5

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