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老年经皮冠状动脉介入治疗患者急性肾损伤的早期诊断。

Early diagnosis of acute kidney injury in aged patients undergoing percutaneous coronary intervention.

机构信息

Department of Cardiology, Ningbo No. 2 Hospital, Medical School of Ningbo University, Ningbo 315010, China.

Department of Nephrology, Ningbo No. 2 Hospital, Medical School of Ningbo University, Ningbo 315010, China.

出版信息

J Zhejiang Univ Sci B. 2018 May;19(5):342-348. doi: 10.1631/jzus.B1700427.

Abstract

In aged patients, acute kidney injury (AKI) is a common clinical complication after percutaneous coronary intervention (PCI), highlighting the need for timely and certain diagnosis of this disease. A single centre, nested case-control study was conducted, which assessed the usefulness of urinary liver-type fatty acid-binding protein (uL-FABP), neutrophil gelatinase-associated lipocalin (uNGAL), and kidney injury molecule-1 (uKIM-1) for early detection of AKI. One hundred and thirty-two patients at or over 60 years old undergoing PCI were included. Serum creatinine (SCr) was measured before PCI, 24 and 48 h after PCI; uL-FABP, uNGAL, and uKIM-1 were measured before PCI, 6, 24, and 48 h after PCI. We identified 16 AKI patients and selected 32 control patients matched by admission time (<1 week), age (±5 years), and gender. In the receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUCs) for the relative measurements of uL-FABP, uNGAL, and uKIM-1 were 0.809, 0.867, and 0.512 at 6 h after PCI, and 0.888, 0.840, and 0.676 at 24 h after PCI, respectively. AUC for the combination of uL-FABP and uNGAL was 0.899 at 6 h after PCI, and 0.917 at 24 h after PCI. Thus, measurement of uL-FABP and uNGAL levels at 6 and 24 h after PCI may be useful in detecting AKI in aged patients. Measurement of uKIM-1 levels provides inferior predictive power for early diagnosis of AKI.

摘要

在老年患者中,经皮冠状动脉介入治疗(PCI)后急性肾损伤(AKI)是一种常见的临床并发症,这突出表明需要及时、准确地诊断这种疾病。一项单中心、巢式病例对照研究评估了尿肝型脂肪酸结合蛋白(uL-FABP)、中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)和肾损伤分子 1(uKIM-1)在早期检测 AKI 中的有用性。该研究纳入了 132 名年龄在 60 岁及以上行 PCI 的患者。在 PCI 前、PCI 后 24 和 48 小时测量血清肌酐(SCr);在 PCI 前、PCI 后 6、24 和 48 小时测量 uL-FABP、uNGAL 和 uKIM-1。研究识别出 16 例 AKI 患者,并选择了 32 例按入院时间(<1 周)、年龄(±5 岁)和性别匹配的对照患者。在受试者工作特征(ROC)曲线分析中,uL-FABP、uNGAL 和 uKIM-1 的相对测量值在 PCI 后 6 小时的 AUC 分别为 0.809、0.867 和 0.512,在 PCI 后 24 小时的 AUC 分别为 0.888、0.840 和 0.676。uL-FABP 和 uNGAL 联合测量的 AUC 在 PCI 后 6 小时为 0.899,在 PCI 后 24 小时为 0.917。因此,在 PCI 后 6 和 24 小时测量 uL-FABP 和 uNGAL 水平可能有助于检测老年患者的 AKI。uKIM-1 水平的测量对 AKI 的早期诊断提供的预测能力较差。

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