Miah O F, Roy D K, Chowdhury A A, Alam K S, Alam M B, Anwar M R, Dowel F A, Latif A, Hai A N, Mahmud M A, Razzak M A, Ahammod T, Ahammed S U, Mahmud H, Paul R S
Dr Mohammad Omar Faruque Miah, Senior Clinical Pathologist, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh.
Mymensingh Med J. 2018 Apr;27(2):263-269.
Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period. This prospective observational study was carried out in the Department of Nephrology of National Institute of Kidney Diseases & Urology in collaboration with National Institute of Cardiovascular Diseases (NICVD) & Dhaka Shisu Hospital (DSH) from January 2015 to December 2016. Total 120 patients were selected from inpatient ward of cardiovascular surgery department. According to inclusion & exclusion criteria total 80 patients were included who was undergone cardiac valve surgery. Serum samples for pNGAL were collected from study population 6 hours after completion of surgery & stored at -80°C, serum samples were also collected for serum creatinine day before surgery, in 1st post operative day (POD1) & 2nd post operative day (POD2). Total 79 patients undergoing cardiac surgery, who met the inclusion & exclusion criteria, were consecutively included. There were 44 male (55.69%) and 35 female (40.31%) ranged from 15-60 years, with mean age of 36 years. pNGAL level in the blood of AKI patients (244.19±59.61ng/ml) 6 hours after completion of surgery was significantly higher from the non AKI patients (171.73±68.63ng/ml). A positive significant correlation was found between pNGAL 6 hours after completion of surgery & serum creatinine at POD1, POD2. This study demonstrated that level of pNGAL concentration 6 hours after completion of cardiac valve surgery increased before the rise of serum creatinine level & can thus AKI can be detected earlier by pNGAL.
心脏瓣膜手术被认为是最常见的外科手术之一，急性肾损伤（AKI）是其常见且严重的并发症。尽管血清肌酐通常被用作肾功能的指标，但它很难反映术后即刻的肾功能情况。在肾脏受到损伤后的几分钟到几小时内，血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）就会被释放出来。本研究的目的是评估pNGAL在检测术后早期AKI方面优于血清肌酐的程度。这项前瞻性观察性研究于2015年1月至2016年12月在国家肾脏疾病与泌尿外科研究所肾病科与国家心血管疾病研究所（NICVD）及达卡希苏医院（DSH）合作开展。总共从心血管外科住院病房选取了120例患者。根据纳入和排除标准，最终纳入了80例接受心脏瓣膜手术的患者。在手术结束6小时后从研究人群中采集用于检测pNGAL的血清样本，并储存在-80°C，还在手术前一天、术后第1天（POD1）和术后第2天（POD2）采集用于检测血清肌酐的血清样本。总共79例接受心脏手术且符合纳入和排除标准的患者被连续纳入研究。其中有44名男性（55.69%）和35名女性（40.31%），年龄在15至60岁之间，平均年龄为36岁。术后6小时AKI患者血液中的pNGAL水平（244.19±59.61ng/ml）显著高于非AKI患者（171.73±68.63ng/ml）。在手术结束6小时后的pNGAL与POD1、POD2时的血清肌酐之间发现了显著的正相关。这项研究表明，心脏瓣膜手术结束6小时后pNGAL浓度水平在血清肌酐水平升高之前就升高了，因此通过pNGAL可以更早地检测到AKI。
