尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-18可预测心脏手术后急性肾损伤。

Urine neutrophil gelatinase-associated lipocalin and interleukin-18 predict acute kidney injury after cardiac surgery.

作者信息

Xin Chen, Yulong Xiao, Yu Chen, Changchun Cao, Feng Zhou, Xinwei Mu

机构信息

Department of Chest Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China.

出版信息

Ren Fail. 2008;30(9):904-13. doi: 10.1080/08860220802359089.

DOI:10.1080/08860220802359089

PMID:18925531

Abstract

BACKGROUND

About 30-50% patients develop acute kidney injury (AKI) after cardiac surgery, which is still diagnosed by serum creatinine on clinic. However, the increase of serum creatinine is insensitive and delayed. The aim of this study is to test the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are early biomarkers for AKI in patients after cardiac surgery.

METHODS

Thirty-three cases undergoing cardiac surgery were classified into an AKI group and non-AKI group, according to the AKI definition (> 26.5 micromol/L increase of serum creatinine, more than or equal to 50% increase of serum creatinine within 48 h, or a reduction in urine output < 0.5 mL/Kg per hour for more than six hours). The concentrations of serum NGAL, urine NGAL, and urine IL-18 at different time-points were measured.

RESULTS

Nine cases (27.27%) developed postoperative AKI, but diagnosis with serum creatinine was 12-48 h postoperation. The concentrations of serum NGAL were not significantly increased postoperation. The concentrations of urine NGAL and IL-18 were significantly increased in the AKI group, which reached the peak at 2-4 h postoperation, and a more significant difference could be seen after correction for urine creatinine. The concentrations of urine NGAL and IL-18 2 h postoperation, either corrected for urine creatinine or not, showed good sensitivity and specificity. Increased levels of urine NGAL and IL-18 2 h postoperation were significantly correlated with increased level of serum creatinine 12 h postoperation. Logistic regression analysis showed that urine NGAL corrected for urine creatinine 2 h postoperation and urine IL-18 2 h postoperation emerged as powerful independent predictors of AKI after cardiac surgery.

CONCLUSIONS

The concentrations of urine NGAL and IL-18 could be useful biomarkers for AKI in patients after cardiac surgery, especially after correction for urine creatinine.

摘要

背景

约30%-50%的患者在心脏手术后会发生急性肾损伤（AKI），临床上仍通过血清肌酐进行诊断。然而，血清肌酐的升高不敏感且具有延迟性。本研究的目的是验证中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和白细胞介素-18（IL-18）是心脏手术后患者AKI早期生物标志物的假设。

方法

根据AKI定义（血清肌酐升高>26.5微摩尔/升，48小时内血清肌酐升高超过或等于50%，或尿量减少<0.5毫升/千克每小时超过6小时），将33例接受心脏手术的患者分为AKI组和非AKI组。测量不同时间点血清NGAL、尿NGAL和尿IL-18的浓度。

结果

9例（27.27%）患者术后发生AKI，但血清肌酐诊断在术后12-48小时。术后血清NGAL浓度无明显升高。AKI组尿NGAL和IL-18浓度显著升高，在术后2-4小时达到峰值，校正尿肌酐后差异更显著。术后2小时尿NGAL和IL-18浓度，无论是否校正尿肌酐，均具有良好的敏感性和特异性。术后2小时尿NGAL和IL-18水平升高与术后12小时血清肌酐水平升高显著相关。Logistic回归分析显示，术后2小时校正尿肌酐的尿NGAL和术后2小时尿IL-18是心脏手术后AKI的有力独立预测指标。