河北医科大学学报

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NGAL、Cys C在瓣膜病换瓣术后早期诊断急性肾损伤的意义

  

  1. 河北医科大学第二医院心脏外科，河北 石家庄 050000
  • 出版日期:2019-12-25 发布日期:2019-12-26
  • 作者简介:吴春涛（1974-），女，江苏扬州人，河北医科大学第二医院副主任医师，医学博士，从事心脏外科疾病诊治研究。
  • 基金资助:
    河北省医学科学研究重点课题（20100107）

Clinical significance of NGAL and Cys C in early diagnosis of acute kidney injury after valvular disease operation#br#

  1. Department of Cardiac Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
  • Online:2019-12-25 Published:2019-12-26

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摘要： ［摘要］
  目的  探讨血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)和胱抑素C(cystatin C ，Cys C)在瓣膜病换瓣术后并发急性肾损伤(acute kidney injury,AKI)的临床意义。
  方法  选取瓣膜病术后患者90例, 根据是否发生AKI 分为AKI 组(37例)及非AKI 组(53例)。于术前和术后2，4，6，8，12，24，48 h收集血标本,采用酶联免疫吸附测定法检测血清NGAL 浓度，采用肌氨酸氧化酶法测定血肌酐（serum creatinine，SCr）水平，采用免疫投射比浊法测定血清Cys C水平。
  结果  2组SCr水平均呈先升高再降低趋势，AKI组SCr水平变化幅度大于非AKI组，AKI 组SCr术后12 h明显升高，其组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05）。AKI 组血NGAL水平均呈先升高再降低趋势，非AKI 组血NGAL水平逐渐降低，AKI 组血NGAL水平高于非AKI 组，AKI 组血清NGAL术后2 h明显升高，其组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05）。2组血Cys C水平均呈逐渐升高趋势，AKI 组血Cys C水平变化幅度大于非AKI组，AKI 组术后6 h明显升高，其组间、时点间、组间·时点间交互作用差异均有统计学意义（P＜0.05）。
  结论  AKI组瓣膜病换瓣术后2 h血清NGAL浓度明显升高, 术后6 h血清Cys C水平开始升高,两者水平升高的时间均早于SCr。血清NGAL 和Cys C 可作为瓣膜病术后诊断AKI 的早期标志物。

关键词: 心脏瓣膜疾病；急性肾损伤；NGAL, Cys C

Abstract: ［Abstract］Objective〖HTSS〗To assess the clinical significance of neutrophil gelatinase-associated lipocalin(NGAL)and cystatin C （Cys C）for acute kidney injury (AKI) after valvular disease operation.
  〖WTHZ〗Methods〖HTSS〗Ninety patients with valvular disease after surgery were selected and divided into AKI group(37 cases) and non-AKI group(53 cases) according to the occurrence of AKI. Blood samples were collected before surgery and 2,4,6,8,12,24,48 hours after surgery. The serum NGAL level was determined by enzyme-linked immunosorbent assay. The serum creatinine（SCr） levels were determined by creatinine sarcosine oxidase method. The serum Cys C levels were determined by immune projection turbidimetry.
  〖WTHZ〗Results〖HTSS〗SCr levels in both groups increased first and then decreased. The change of SCr level in AKI group was larger than that in non-AKI group. SCr in AKI group increased significantly at 12 h after surgery. There were statistically significant differences between two groups, time points and their interaction(P＜0.05). Serum NGAL level in the AKI group increased first and then decreased, while serum NGAL level in the non-AKI group decreased gradually. Serum NGAL level in the AKI group was higher than that in the non-AKI group. Serum NGAL level in the AKI group increased significantly at 2 h after surgery. There were statistically significant differences between groups, time points and their interaction(P＜0.05). The level of blood Cys C increased gradually in twe groups. The variation amplitude of serum Cys C level in AKI group was greater than that in non-AKI group. Serum Cys C level in the AKI group increased significantly at 6h after surgery. There were statistically significant differences between groups, time points and their interaction(P＜0.05). 
  〖WTHZ〗Conclusion〖HTSS〗Serum NGAL concentration of the AKI group increased significantly at 2 h after valvular disease replacement. Serum Cys C level of the AKI group began to increase at 6 h after surgery. The increase time of both was earlier than the increase time of SCr level. Serum NGAL and serum Cys C can be used as markers for the early diagnosis of AKI after valvular disease operation.

Key words: heart valve diseases, acute kidney injury, neutrophil gelatinase-associated lipocalin, cystatin C

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