Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
J Thorac Cardiovasc Surg. 2010 May;139(5):1101-6. doi: 10.1016/j.jtcvs.2009.11.007.
Acute kidney injury is a common and significant problem that occurs in a wide variety of clinical settings. Cardiac surgery-associated acute kidney injury continues to be a well-recognized complication of cardiac surgery with associated morbidity and mortality. A lack of early biomarkers for acute kidney injury has prevented timely interventions to mitigate the effects of acute kidney injury. Because serum creatinine is not a timely marker of acute kidney injury, it cannot be used to institute potentially effective therapies to treat acute kidney injury in patients during phases when the injury is still potentially reversible. Neutrophil gelatinase-associated lipocalin has been identified as a promising biomarker for early detection of acute kidney injury. Several studies have shown that neutrophil gelatinase-associated lipocalin levels increase significantly in patients with acute kidney injury 24 to 48 hours before an increase in serum creatinine is detectable. Recent studies suggest that measurements of neutrophil gelatinase-associated lipocalin levels in patients at risk for cardiac surgery-associated acute kidney injury can facilitate its early diagnosis and allow clinicians to implement therapeutic adjustments that have the potential to reverse renal cellular damage and minimize further kidney injury.
急性肾损伤是一种在广泛的临床环境中发生的常见且严重的问题。心脏手术相关的急性肾损伤仍然是心脏手术的一个公认的并发症，与之相关的发病率和死亡率较高。由于缺乏急性肾损伤的早期生物标志物，因此无法及时进行干预以减轻急性肾损伤的影响。由于血清肌酐不是急性肾损伤的及时标志物，因此不能用于在损伤仍然具有潜在可逆性的阶段对患者的急性肾损伤进行潜在有效的治疗。中性粒细胞明胶酶相关脂质运载蛋白已被确定为急性肾损伤早期检测的有前途的生物标志物。多项研究表明，急性肾损伤患者的中性粒细胞明胶酶相关脂质运载蛋白水平在血清肌酐可检测到之前的 24 至 48 小时内显著升高。最近的研究表明，对有心脏手术相关急性肾损伤风险的患者进行中性粒细胞明胶酶相关脂质运载蛋白水平的测量有助于早期诊断，并使临床医生能够进行治疗调整，有可能逆转肾细胞损伤并最大限度地减少进一步的肾损伤。
