胱抑素C、肾损伤分子-1、血肌酐在先天性心脏病体外循环术所致急性肾损伤早期预警中的临床价值

Clinical value of CyS C, Kim-1 and SCr in acute kidney injury induced by cardiopulmonary bypass of patients with congenital heart diseases

摘要:

目的  探讨胱抑素C（CyS C）、肾损伤分子-1（Kim-1）、血肌酐（SCr）在先天性心脏病（以下简称先心病）体外循环术（CPB）所致急性肾损伤（AKI）早期预警中的临床价值。方法  选取2014年5月-2014年12月收住入院的先心病患者100例，将CPB术后发生AKI患者26例作为Ⅰ组，术后未发生AKI患者74例作为Ⅱ组。比较分析两组CPB前及术后各时间CyS C、Kim-1、SCr水平，以及SCr、尿量（UPD）的变化。结果  CPB前，两组CyS C、Kim-1、SCr水平比较，差异无统计学意义（P >0.05）；Ⅱ组术后CyS C、Kim-1、SCr水平与术前比较，差异无统计学意义（P >0.05）；Ⅰ组术后2 h CyS C、6 h Kim-1升高，并在术后12 h达峰值（P <0.05），SCr术后即开始逐步升高，术后12 h达小高峰，其后缓慢升高（P <0.05）；术后各时间段Ⅰ组CyS C、Kim-1、SCr水平高于同时间Ⅱ组水平（P <0.05），但UPD低于Ⅱ组，差异有统计学意义（P <0.05）；KIM-1、Cys C、SCr联合检测受试者工作特征曲线下面积最大，为0.8563，高于SCr和UPD联合检测的0.7135。结论  先心病CPB术后发生AkI的概率较高（26%）；CyS C、Kim-1在AKI发生的超早期即升高，而SCr在AKI发生过程中呈相对缓慢升高的态势，相较于传统的SCr、UPD联合检测，KIM-1、Cys C、SCr联合检测在先心病行CPB所致AKI早期预警中具有更高的临床价值，值得大力推广。

Abstract:

Objective To investigate the clinical value of cystatin C (CyS C), kidney injury molecule-1 (Kim-1) and serum creatinine (SCr) in early warning of acute kidney injury (AKI) induced by cardiopulmonary bypass (CPB) of congenital heart diseases. Methods A total of 100 patients hospitalized into our hospital from January to December 2014 for congenital heart diseases were chosen as study subjects. Among them 26 patients who had AKI after CPB were into group Ⅰ, and the remaining 74 patients without AKI were into group Ⅱ. The changes of CyS C, Kim-1, SCr and urinary production (UPD) were compared between the two groups before CPB and at each time point after CPB. Results Before CPB surgery, there was no significant difference in CyS C, Kim-1 or SCr between the two groups (P > 0.05). In the group Ⅱ, the post-operative CyS C, Kim-1 and SCr increased slightly compared with the preoperative values, the differences were not significant (P > 0.05). In the group Ⅰ, CyS C at 2 h after CPB significantly increased, Kim-1 at 6 h after CPB significantly increased, both of them reached the maximum at 12 h (P < 0.05); SCr began to rise after CPB, reached the peak at 12 h after CPB, after that it increased slowly (P < 0.05). At each time point after CPB, CyS C, Kim-1 and SCr of the group Ⅰ were significantly higher than those of the group Ⅱ (P < 0.05); while UPD was lower than that of the group Ⅱ (P < 0.05). The combined detection of KIM-1, Cys C and SCr had the biggest ROC area under the curve, which was 0.8563 and significantly higher than that of UPD and SCr (0.7135). Conclusions The occurrence of AKI is high in patients with congenital heart diseases (26%). CyS C and Kim-1 can significantly increase at the ultra-early time of AKI, but SCr increases quite slowly. Compared to the traditional combined detection of SCr and UPD, the combined detection of KIM-1, Cys C and SCr has a greater clinical value in early warning of acute kidney injury induced by CPB in patients with congenital heart diseases, it is worth promoting.