本文選題：腎功能衰竭　切入點(diǎn)：急性　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的探討血、尿中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白(neutiophilgelatinase-associated lipocalin, NGAL)對(duì)成人心臟瓣膜置換術(shù)后急性腎損傷(acutekidney injury, AKI)的早期診斷價(jià)值。 方法前瞻性收集56例接受心臟瓣膜置換手術(shù)的成人患者術(shù)前及術(shù)后2、4、8、12及24h的靜脈血液及尿液標(biāo)本，分別測(cè)定血、尿NGAL及血肌酐(serum creatinine,Scr)，術(shù)后根據(jù)Scr水平將患者分為AKI組和非AKI組，用受試者工作特征（ROC）曲線評(píng)價(jià)血、尿NGAL對(duì)心臟瓣膜置換術(shù)后AKI的早期診斷價(jià)值。 結(jié)果 1.56例患者中有16例發(fā)生AKI，，發(fā)生率為28.57%。 2. AKI組Scr峰值出現(xiàn)在術(shù)后12～24h內(nèi)。 3. AKI組術(shù)后2h血NGAL開始顯著升高，4h時(shí)達(dá)峰值，與基礎(chǔ)值(術(shù)前水平)比較差異有統(tǒng)計(jì)學(xué)意義（p0.05），術(shù)后尿NGAL較基礎(chǔ)值上升（p0.05），并在2h時(shí)達(dá)高峰。AKI組血NGAL水平在術(shù)后8h及其以后各時(shí)間點(diǎn)保持較高水平，與基礎(chǔ)值相比差異有統(tǒng)計(jì)學(xué)意義（p0.05），尿NGAL在術(shù)后4h及其以后各時(shí)間點(diǎn)均保持較高水平，但自術(shù)后12h起NGAL水平與基礎(chǔ)值相比差異無統(tǒng)計(jì)學(xué)意義（p㧐0.05）。 4. AKI組術(shù)后4h血NGAL診斷AKI的ROC曲線下面積為0.891，95%的可信區(qū)間為0.809～0.920，以50μg/L作為AKI的診斷界限時(shí)表現(xiàn)出較高的敏感性及特異性；術(shù)后2h尿NGAL診斷AKI的ROC曲線下面積為0.934，95%的可信區(qū)間為0.871～0.998，以110μg/L作為診斷界限時(shí)表現(xiàn)出較高的敏感性及特異性。結(jié)論 .成人心臟瓣膜置換術(shù)后Scr診斷AKI較血、尿NGAL診斷滯后約20h，術(shù)后4h血液及術(shù)后2h尿液NGAL可作為AKI發(fā)生的早期診斷標(biāo)志物。
[Abstract]:Objective to investigate the value of neutiophilia gelatinase-associated lipocalin (NGALs) in the early diagnosis of acute renal injury after cardiac valve replacement in adults.Methods the venous blood and urine samples were collected from 56 adult patients undergoing cardiac valve replacement before and after cardiac valve replacement. The blood, urine NGAL and creatinine creatinine creatinine were measured before and after operation. The patients were divided into AKI group and non-#en3# group according to the level of Scr after operation.The value of blood and urine NGAL in early diagnosis of AKI after cardiac valve replacement was evaluated by using the operating characteristics of subjects.Result1. AKI was found in 16 of 56 patients (28.57%).2.The peak value of Scr in AKI group appeared within 24 hours after operation.3.In AKI group, the serum NGAL increased significantly at 2 h after operation and reached the peak at 4 h after operation.Compared with the basic value (preoperative level), the difference was statistically significant (p0.05). The urine NGAL increased after operation compared with the basic value, and reached the peak at 2 h. The level of serum NGAL in the AKI group maintained a high level at 8 hours after the operation and at every time point after the operation.Compared with the basic value, the difference was statistically significant (p 0.05), and the level of urinary NGAL remained high at 4 h after operation and at every time point after operation, but there was no significant difference between the level of NGAL and the basic value since 12 h after operation.4.In the AKI group, the area under the ROC curve was 0.891V 95% and the confidence interval under the ROC curve was 0.809 鹵0.920. The sensitivity and specificity of 50 渭 g / L as the diagnostic limit for AKI were higher than those in the control group.2 hours after operation, the area under the ROC curve of urine NGAL was 0.934 鹵95%. The confidence interval of 0.871g / L was 0.998.The sensitivity and specificity were higher when 110 渭 g / L was used as the diagnostic limit.Conclusion.The diagnosis of AKI by Scr after cardiac valve replacement in adults was more than that by blood, and the diagnosis of NGAL in urine was delayed by about 20 hours. NGAL in blood 4 hours after operation and in urine at 2 hours after operation could be used as an early diagnostic marker for the occurrence of AKI.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R654.2;R692

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本文編號(hào)：1722032