【摘要】：目的探討尿中性粒細胞明膠酶載脂蛋白(NGAL)和腎損傷因子1(KIM-1)在造影劑早期腎損傷中的診斷價值,評估水化治療對造影劑腎病(CIN)的預防作用。 方法選擇經(jīng)皮冠狀動脈介入治療(PCI)患者120例,隨機分為水化治療組(60例)和對照組(60例)。PCI術前6h始給予水化治療組患者靜脈補液至術后12h。采用自動生化儀分別檢測定患者術前(TO)、術后12h (T1)、24h (T2)、48h (T3)、72h (T4)的血Scr、BUN、血漿胱抑素C (Cys-C)及尿微量白蛋白(mAlb)變化,ELISA法檢測尿NGAL和尿KIM-1水平,檢測尿al-微球蛋白(a1-MG)、尿N-Z酰一β-D氨基葡萄糖苷酶(NAG)。 結果(1)120例受試者中有87例患者PCI術后12h出現(xiàn)尿NGAL/Cr和KIM-1/Cr升高至基線值的兩倍以上,發(fā)生CIN8例6.67%),其中水化治療組l例(1.7%),對照組7例(11.7%),兩組比較差異有統(tǒng)計學意義(P0.05)。(2)兩組患者血BUN、Scr、mAlb/Cr、Cys-C、GFR的差異無統(tǒng)計學意義(均P0.05)。(3)兩組患者尿a1-MG、NAG水平均于術后24h升高。水化治療組術后72h基本回落至術前水平,與對照組比較差異有統(tǒng)計學意義(P0.01)。(4)兩組患者尿NGAL、KIM-1水平均于術后12h升高。水化治療組術后72h基本回落至術前水平,與對照組比較差異有統(tǒng)計學意義(P0.01)。(5)兩組患者PCI術后12h NGAL/Cr、KIM-1/Cr的ROC曲線下面積(AUC)分別為0.931、0.811,組間比較差異有統(tǒng)計學意義(P0.05)。 結論NGAL和KIM-1是診斷造影劑早期腎損傷敏感和特異性的指標,水化治療可預防造影劑腎病的發(fā)生。
[Abstract]:Objective to investigate the diagnostic value of urinary neutrophil gelatinase apolipoprotein (NGAL) and renal injury factor-1 (KIM-1) in early renal injury and evaluate the preventive effect of hydration on contrast agent nephropathy (cin). Methods 120 patients with percutaneous coronary intervention (PCI) were randomly divided into hydration group (n = 60) and control group (n = 60). The levels of urinary NGAL and urinary KIM-1 were detected by automatic biochemical instrument before operation (to), 12 h (T1), 48 h (T 3) and 72 h (T 4), plasma cystatin C (Cys-C) and urinary microalbumin (mAlb) were determined by Elisa. Urine al- microglobulin (a1-MG) and urine N-Z acyl-尾-D glucosaminidase (nag) were detected. Results (1) in 87 of 120 subjects, urinary NGAL-Cr and KIM-1 / Cr increased more than twice the baseline value 12 hours after PCI. The incidence of CIN8 was 6.67%, including 1 case (1.7%) in hydration treatment group and 7 cases (11.7%) in control group. There was a significant difference between the two groups (P0.05). (2). There was no significant difference between two groups (P0.05). (3) in urine a1-MGNAG level of two groups (P0.05). (3). The levels of urinary NGALL KIM-1 in hydration treatment group were significantly higher than those in control group (P0.01). (4) at 12 hours after operation. In the hydration treatment group, the area under the ROC curve was 0.931 鹵0.811 at the 12th hour after PCI (P0.01). (5), and there was significant difference between the two groups (P0.05). Conclusion NGAL and KIM-1 are sensitive and specific indexes in the diagnosis of early renal injury in contrast medium. Hydration therapy can prevent the occurrence of contrast agent nephropathy.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5

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