本文關(guān)鍵詞：成人心臟體外循環(huán)術(shù)后急性腎損傷與中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白表達(dá)相關(guān)性研究　出處：《中國實(shí)用內(nèi)科雜志》2016年06期 　論文類型：期刊論文

  更多相關(guān)文章： 體外循環(huán) 急性腎損傷 中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白

【摘要】：目的探討中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白(neutrophil gelatinase-associated lipocalin,NGAL)在心臟體外循環(huán)術(shù)(cardiopulmonary bypass,CPB)后急性腎損傷(AKI)早期診斷中的價(jià)值,為CPB-AKI患者的早期診斷和預(yù)防提供簡便、可靠的循證醫(yī)學(xué)證據(jù)。方法選取2010年12月至2011年5月入住上海長海醫(yī)院心胸外科接受擇期體外循環(huán)手術(shù)的住院患者64例,其中男32例,女32例;年齡平均(53.8±12.0)歲。按KDIGO指南診斷標(biāo)準(zhǔn),分為非AKI組及AKI組,采集患者術(shù)前及術(shù)后各時(shí)間點(diǎn)的靜脈血及尿液標(biāo)本,酶法測定血清肌酐,ELISA方法檢測尿NGAL(uNGAL)表達(dá),運(yùn)用受試者工作特征曲線(receiver operator characteristic,ROC)及曲線下面積(area under the curve,AUC)評估尿NGAL表達(dá)水平與腎損傷程度之間的關(guān)系。結(jié)果 64例體外循環(huán)手術(shù)后患者10例發(fā)生AKI(15.6%);與非AKI組相比,AKI組術(shù)后2 h起uNGAL表達(dá)明顯升高,Cut off值在296μg/L時(shí),其診斷AKI的敏感度和特異度分別為90.0%和79.6%;術(shù)后2 h的uNGAL與術(shù)后24 h血肌酐(Scr)呈正相關(guān)。結(jié)論 CPB-AKI患者uNGAL表達(dá)水平較非AKI組明顯增加,其增加程度與AKI嚴(yán)重程度呈正相關(guān),uNGAL可作為CPB-AKI患者早期診斷的敏感指標(biāo)。
[Abstract]:Objective to investigate the expression of neutrophil gelatinase associatedlipocalin (neutrophil gelatinase-associated, lipocalin, NGAL) in cardiopulmonary bypass (cardiopulmonary bypass, CPB) after acute kidney injury (AKI) in the early diagnosis value for early diagnosis and prevention of CPB-AKI patients to provide a simple, reliable evidence based medicine methods from December 2010 to May 2011. Department of cardiothoracic surgery at Changhai Hospital of Shanghai underwent surgery undergoing cardiopulmonary bypass in 64 cases, male 32 cases, female 32 cases; the average age (53.8 + 12) years old. According to the standard guidelines for the diagnosis of KDIGO, divided into non AKI group and AKI group. The blood and urine samples were collected before and after the operation at each time point determination of serum creatinine, enzyme method, ELISA method for detection of urinary NGAL (uNGAL) expression, using the receiver operating characteristic curve (receiver operator characteristic ROC (area) and area under curve UN Der the curve, AUC) to evaluate the relationship between urinary NGAL expression and renal damage. Results 64 cases of off-pump surgery occurred in 10 cases of AKI (15.6%); compared with the non AKI group, AKI group after 2 h significantly increased the expression of uNGAL, Cut and off values at 296 g/L, its diagnosis the sensitivity and specificity of AKI were 90% and 79.6%; after uNGAL operation and 2 h after 24 h serum creatinine (Scr) were positively correlated with CPB-AKI. Conclusion the expression level of uNGAL compared with non AKI group increased significantly, the increase was positively correlated with the severity of the AKI, uNGAL may be a sensitive index of early diagnosis of CPB-AKI patients broken.

【作者單位】： 武警江蘇總隊(duì)醫(yī)院腎內(nèi)科;第二軍醫(yī)大學(xué)附屬長海醫(yī)院心胸外科;解放軍腎臟病研究所第二軍醫(yī)大學(xué)附屬長征醫(yī)院腎內(nèi)科;
【基金】：國家十二五支撐計(jì)劃(2011BAI10B07)
【分類號】：R692;R654.2
【正文快照】： 心臟體外循環(huán)術(shù)(cardiopulmonary bypass,CPB)后急性腎損傷(acute kidney injury,AKI)發(fā)生率可高達(dá)30%~55%,是顯著增加患者死亡風(fēng)險(xiǎn)的獨(dú)立危險(xiǎn)因素之一[1]。早期診斷、及時(shí)干預(yù)可有效改善其預(yù)后。中性粒細(xì)胞明膠酶相關(guān)性脂質(zhì)運(yùn)載蛋白(neutrophil gelatinase-associated lipoca

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