Luo Qun, Zhou Fangfang, Dong Hong, Wu Lingping, Chai Lingxiong, Lan Kai, Wu Minxiang
Division of Nephrology, Ningbo NO.2 Hospital, Affiliated Hospital of Ningbo University School of Medical, Ningbo city, Zhejiang province, PR China.
Clin Nephrol. 2013 Feb;79(2):85-92. doi: 10.5414/CN106852.
Kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin 18 (IL-18) are three of the most promising biomarkers for the early detection of acute kidney injury. In the present study, to determine whether a combination of the three biomarkers enhances their predictive value, representing an ideal indicator for the early detection of Acute Kidney Injury (AKI) we examined 118 adults undergoing elective percutaneous coronary intervention (PCI).
We performed a single center, nested case-control study. Urinary KIM-1, NGAL and IL-18 were measured by enzyme-linked immunosorbent assay before and 6 h, 24 h, 48 h postcontrast. Serum creatinine was measured before and 24 h, 48 h postcontrast.
12 patients (10.1%) were identified with AKI. 30 patients were selected as controls, matched with cases at an attempted 2.5 : 1 ratio. Compared to the non-AKI group, urinary NGAL were significantly higher at all the time-points. Urinary KIM-1 and IL-18 levels were significantly higher at 24 h and 48 h postcontrast. In the AKI group, Urinary NGAL peaked at 6 h postcontrast, and then decreased. Both KIM-1 and IL-18 peaked at 24 hours postcontrast, remained markedly elevated up to 48 h. By applying area under the receiver operator characteristic curve, the combination of KIM-1, NGAL and IL-18 had the most powerful diagnostic power (AUC = 0.99, (95%CI: 0.90 - 1.00), p = 0.0001) for diagnosis of AKI at 24 h postcontrast, superior to that for single detection and serum creatinine.
KIM-1, NGAL and IL-18 were increased in tandem after PCI. The combination of urinary biomarkers may allow for early detection of AKI following PCI, better than serum creatinine, and the individual biomarkers.
肾损伤分子-1（KIM-1）、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）是急性肾损伤早期检测中最具潜力的三种生物标志物。在本研究中，为了确定这三种生物标志物的组合是否能提高其预测价值，从而成为急性肾损伤（AKI）早期检测的理想指标，我们对118例接受择期经皮冠状动脉介入治疗（PCI）的成年人进行了研究。
我们开展了一项单中心、巢式病例对照研究。在造影剂注射前以及注射后6小时、24小时、48小时，通过酶联免疫吸附测定法检测尿KIM-1、NGAL和IL-18水平。在造影剂注射前以及注射后24小时、48小时检测血清肌酐水平。
12例患者（10.1%）被诊断为AKI。选取30例患者作为对照，按照约2.5:1的比例与病例进行匹配。与非AKI组相比，尿NGAL在所有时间点均显著升高。尿KIM-1和IL-18水平在造影剂注射后24小时和48小时显著升高。在AKI组中，尿NGAL在造影剂注射后6小时达到峰值，随后下降。KIM-1和IL-18均在造影剂注射后24小时达到峰值，直至48小时仍显著升高。通过应用受试者操作特征曲线下面积，KIM-1、NGAL和IL-18的组合在造影剂注射后24小时诊断AKI的诊断能力最强（AUC = 0.99，（95%CI：0.90 - 1.00），p = 0.0001），优于单项检测及血清肌酐。
PCI术后KIM-1、NGAL和IL-18同时升高。尿生物标志物的组合可能比血清肌酐及单个生物标志物能更好地实现PCI术后AKI的早期检测。
