Liu Huajie, Shen Yunlin, Sun Lei, Kuang Xinyu, Zhang Rufang, Zhang Hong, Zhou Junmei, Li Xiaobing, Huang Wenyan
Department of Nephrology and Rheumatology, Children's Hospital of Shanghai Jiao Tong University, Shanghai.
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Zhonghua Er Ke Za Zhi. 2014 Jul;52(7):494-9.
To investigate the new biomarkers of acute kidney injury, as well as to confirm the values of response gene to complement 32 (RGC-32) for early diagnosis of acute kidney injury by comparing the values of serum creatinine (Scr) and cystatin C (CysC) in children who had undergone cardiopulmonary bypass (CPB).
Sixty-seven patients who had accepted CPB were recruited from the cardiac surgery intensive care unit, Children's Hospital Affiliated to Shanghai Jiao Tong University from March to June 2013 and assigned to acute kidney injury group (group AKI) or non-acute kidney injury group (group non-AKI), on the basis of the definition by the pediatric RIFLE (pRIFLE) criteria. Also 30 healthy control children were recruited. Serum samples were taken regularly from each patient after CPB at 30 min, 2 h, 4 h, 24 h, 48 h and 72 h for RGC-32. Serum samples were tested by enzyme linked immunosorbent assay (ELISA) which was employed to determine the levels of serum RGC-32. Scr and CysC were analyzed by HITACHI 7180 automatic biochemical analyzer. All the data were analyzed by receiver operator characteristic curve (ROC) and area under curve (AUC).
The incidence of AKI was 34% (23/67), including 15 cases with risk stage AKI, 4 cases with injury stage AKI, 3 cases with failure stage AKI, 1 cases with loss stage AKI. Three out of four subjects with Failure stage AKI and the one case with Loss stage all accepted renal replacement therapy. CPB group had a higher level of serum RGC-32 than that of pre-operation after CPB 30 minute [(2.88 ± 0.68) µg/L vs. (1.39 ± 0.31) µg/L, P < 0.05]. At the same time, comparing with the non-AKI group, the levels of serum RGC-32 were higher than that of controls 30 min, 2 h, 4 h, 24 h and 48 h after CPB (t = 2.560, 2.180, 2.818, 2.226, 3.017; P < 0.05). The values for the AUC were determined for RGC-32 as 0.770, 0.707, 0.768, 0.728,0.723 and 0.770 after CPB 30 min, 2 h, 4 h, 24 h, 48 h and 72 h. The values for sensitivity of serum RGC-32 30 min, 2 h and 4 h after CPB was 0.914, 0.824, 0.824 and the values for specificity of serum RGC-32 was 0.619, 0.667, 0.810, respectively. But the values for sensitivity of CysC was 0.625, 0.813, 0.813, and specificity 0.571, 0.619, 0.571, respectively. The values for sensitivity of Scr was 0.625, 0.625, 0.813 and specificity was 0.571, 0.571, 0.524, respectively.
The sensitivity of serum RGC-32 for detecting AKI was much higher than that of Scr and serum CysC in children who had accepted CPB, and that RGC-32 may be a new biomarker for early detection of AKI. However, the conclusion needs to be further elucidated.
探讨急性肾损伤的新生物标志物，并通过比较体外循环（CPB）患儿血清肌酐（Scr）和胱抑素C（CysC）的值，确定补体反应基因32（RGC-32）在急性肾损伤早期诊断中的价值。
选取2013年3月至6月在上海交通大学附属儿童医院心脏外科重症监护病房接受CPB的67例患者，根据儿科RIFLE（pRIFLE）标准定义分为急性肾损伤组（AKI组）和非急性肾损伤组（非AKI组）。另招募30例健康对照儿童。CPB后30分钟、2小时、4小时、24小时、48小时和72小时定期采集每位患者的血清样本检测RGC-32。采用酶联免疫吸附测定（ELISA）检测血清样本，以测定血清RGC-32水平。Scr和CysC采用日立7180全自动生化分析仪进行分析。所有数据采用受试者工作特征曲线（ROC）和曲线下面积（AUC）进行分析。
AKI发生率为34%（23/67），其中风险期AKI 15例，损伤期AKI 4例，衰竭期AKI 3例，丢失期AKI 1例。4例衰竭期AKI患者中的3例和1例丢失期患者均接受了肾脏替代治疗。CPB组术后30分钟血清RGC-32水平高于术前[（2.88±0.68）μg/L比（1.39±0.31）μg/L，P<0.05]。同时，与非AKI组比较，CPB后30分钟、2小时、4小时、24小时和48小时血清RGC-32水平高于对照组（t=2.560、2.180、2.818、2.226、3.017；P<0.05）。CPB后30分钟、2小时、4小时、24小时、48小时和72小时RGC-32的AUC值分别为0.770、0.707、0.768、0.728、0.723和
