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目的检测并评价手术后急性肾损伤(PO-AKI)患者尿液中巢蛋白(nestin)、中性粒细胞明胶酶相关性脂质运载蛋白(NGAL)、尿损伤因子(KIM-1)、视黄醇结合蛋白(RBP)4种生物标志物对于急性肾损伤(AKI)早期诊断的检验效能。方法以2011年10月上海交通大学医学院附属瑞金医院心脏外科手术后的40例患者作为研究对象,其中男28例,女12例;年龄24～79岁,平均(56.15±12.83)岁。根据急性肾损伤网络工作小组(AKIN)定义分为AKI组和非AKI组。尿液生物标志物组的检测采用酶联免疫法(ELISA),同时检测实时尿肌酐值。结果 AKI发生率为25%(10/40),其中AKIN 1级7例、2级1例、3级2例,3级中2例均进行了肾脏替代治疗(RRT)。联合生物标志物组nestin、NGAL、KIM-1、RBP对于AKI的检测在24 h时间窗内明显升高(P<0.05),并且经尿肌酐(Ucr)校正后在6 h内升高更加显著(P<0.05)。结论联合生物标志物组对于AKI的检测在24 h内明显升高,经过Ucr校正后6 h升高趋势更加一致,对于早期判断AKI具有预警作用。
Objective To detect and evaluate the urine levels of nestin, neutrophil gelatinase-associated lipocalin (NGAL) and urinary injury factor (KIM-1) in patients with acute kidney injury (PO-AKI) The efficacy of 4 biomarkers of RBP in the early diagnosis of acute kidney injury (AKI). Methods Forty patients (28 males and 12 females, aged 24-79 years old, average 56.15 ± 12.83 years old) undergoing cardiac surgery in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine in October 2011 were included in this study. According to the definition of acute kidney injury network working group (AKIN) is divided into AKI group and non-AKI group. Urine biomarker assay was detected by enzyme-linked immunosorbent assay (ELISA) and real-time urine creatinine was measured. Results The incidence of AKI was 25% (10/40). There were 7 cases of AKIN grade 1, 1 case of grade 2, 2 cases of grade 3 and 2 cases of grade 3 renal replacement therapy (RRT). The detection of AKI by nestin, NGAL, KIM-1 and RBP in the group of combined biomarkers was significantly increased in 24 h time window (P <0.05), and more significantly increased within 6 h after corrected by urinary creatinine (Ucr) (P <0.05). Conclusions The detection rate of AKI in the combined biomarker group increased significantly within 24 h and increased more consistently at 6 h after Ucr calibration, which may be an early warning for the early diagnosis of AKI.