慢性心力衰竭急性失代偿患者急性肾损伤的早期诊断

Early diagnosis of acute renal injury in patients with acute decompensation of chronic heart failure.

作者信息

Nasonova S N, Zhirov I V, Ledyakhova M V, Sharf T V, Bosykh E G, Masenko V P, Tereshchenko S N

机构信息

National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia.

Russian Medical Academy Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, Russia.

出版信息

Ter Arkh. 2019 May 16;91(4):67-73. doi: 10.26442/00403660.2019.04.000168.

DOI:10.26442/00403660.2019.04.000168

PMID:31094479

Abstract

AIM

To study the possibilities of previously diagnosing acute renal damage in patients with acute decompensation of chronic heart failure with reduced systolic function using biomarkers of acute renal injury.

MATERIALS AND METHODS

The study included 60 patients (62.0±11.1 years) with HADS (BNP >500 pg/ml) and a reduced left ventricular ejection fraction (LV 27.05% [23.25; 32.75], c FC III-IV NYHA). The level of creatinine, urea, uric acid, albumin in serum was determined in all patients, as well as a number of biomarkers: lipocalin associated with neutrophil gelatinase (NGAL) and cystatin C (CysC) in serum; kidney damage molecule-1 (KIM-1) and angiotensinogen (AGT) in the urine.

RESULTS

AKI is determined based on changes in serum creatinine concentration or diuresis value. The results obtained indicate a high specificity and sensitivity of the use of biomarkers for the diagnosis of AKI in patients with ADHF. NGAL AUC - 0.833 (p<0.001), Se - 82.8%, Sp - 4.2%. CysC AUC - 0.823 (p<0.001), Se - 79.3%, Sp - 74.2%. KIM-1 AUC - 0.782 (p<0.001), Se - 75.9%, Sp - 74.2%. AGT AUC - 0.829 (p<0.001), Se - 82.8%, Sp - 77.4%. In a multifactorial regression analysis, it was found that with NGAL greater than 157.35 ng/ml, the risk of AKI increases 13.1 times (95% CI 1.365-126.431), with an increase in KIM-1, the risk of the development of AKI increases 20.6 times (95% CI 1.802-235.524), and with an increase in AGT more than 14.31 leng/ml, the risk of AKI increases 32.8 times (95% CI 2.752-390.110).

CONCLUSION

Acute kidney injury develops in 48.3% of patients hospitalized with acute decompensation of chronic heart failure. Patients with acute decompensation of chronic heart failure and AKI have significantly higher serum NGAL and CysC, KIM-1 and AGT values in the urine compared with patients without impairing renal function. These biomarkers can serve both for the early diagnosis of acute kidney damage and the prediction of AKI in patients with acute decompensation of chronic heart failure.

摘要

目的

研究使用急性肾损伤生物标志物对收缩功能降低的慢性心力衰竭急性失代偿患者进行急性肾损伤早期诊断的可能性。

材料与方法

本研究纳入60例患者（年龄62.0±11.1岁），其脑钠肽（BNP）>500 pg/ml且左心室射血分数降低（左心室射血分数为27.05%[23.25；32.75]，纽约心脏病协会心功能分级为III-IV级）。测定所有患者血清中的肌酐、尿素、尿酸、白蛋白水平，以及多种生物标志物：血清中与中性粒细胞明胶酶相关的lipocalin（NGAL）和胱抑素C（CysC）；尿液中的肾损伤分子-1（KIM-1）和血管紧张素原（AGT）。

结果

根据血清肌酐浓度或尿量值的变化来确定急性肾损伤（AKI）。所得结果表明，使用生物标志物诊断急性失代偿性心力衰竭（ADHF）患者的AKI具有较高的特异性和敏感性。NGAL的曲线下面积（AUC）为0.833（p<0.001），敏感性（Se）为82.8%，特异性（Sp）为4.2%。CysC的AUC为0.823（p<0.001），Se为79.3%，Sp为74.2%。KIM-1的AUC为0.782（p<0.001），Se为75.9%，Sp为74.2%。AGT的AUC为0.829（p<0.001），Se为82.8%，Sp为77.4%。在多因素回归分析中发现，当NGAL大于157.35 ng/ml时，AKI风险增加13.1倍（95%置信区间为1.365-126.431），KIM-1升高时，AKI发生风险增加20.6倍（95%置信区间为1.802-235.524），AGT大于14.31 leng/ml时，AKI风险增加32.8倍（95%置信区间为2.752-390.110）。