Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study.
Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study.
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DOI：
10.1186/s40560-014-0045-4
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发表时间：
2014
影响因子：
7.1
通讯作者：
Fujino Y
中科院分区：
文献类型：
--
作者：
Ueta K;Watanabe M;Iguchi N;Uchiyama A;Shirakawa Y;Kuratani T;Sawa Y;Fujino Y
急性肾损伤（阿基）是一种常见且严重的疾病，通常在发病后一段时间通过血清肌酐（sCr）的变化检测到。尽管用于修复主动脉瘤的支架移植术与外科手术或使用造影剂引起的阿基相关，但尚未在支架移植物接受者中充分检查阿基的早期生物标志物。我们研究了包括尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、血NGAL、N-乙酰基-β-d-氨基葡萄糖苷酶（NAG）、微量白蛋白（Alb）和肝脂肪酸结合蛋白（L-FABP）在内的生物标志物，作为接受主动脉瘤支架移植修复术的患者中阿基的前瞻性早期生物标志物。除术前采样外，在术后2 - 6 h和1、3 - 4和5天或之后（直至稳定），还对47例接受主动脉瘤覆膜支架修复术的患者进行了尿液和血清生物标志物采样。使用急性肾损伤网络标准，42名留院患者中有6名（14%）出现阿基。用尿Cr校正的NGAL（NGAL/Cr）值显示了阿基的最佳预测值（在65.1 μg/gCr临界值时，特异性为97%，灵敏度为83%）。术后2 h NGAL/Cr值的受试者-操作者特征曲线下面积为0.9。尽管阿基患者的NGAL/Cr、经尿Cr校正的L-FABP/Cr、L-FABP、NAG和经尿Cr校正的Alb（Alb/Cr）均在sCr检测阿基前达到峰值，但调整截断值后，所有生物标志物均在阿基检测前达到截断值。主动脉瘤覆膜支架修复后，NGAL/Cr是阿基的潜在有用的早期生物标志物。
Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminidase (NAG), microalbumin (Alb), and liver fatty acid-binding protein (L-FABP) as prospective early biomarkers for AKI in patients who had received stent graft repairs of aortic aneurysms. In addition to pre-surgical sampling, at 2 to 6 h and at 1, 3 to 4, and 5 days or later (until stable) after surgery, urine and serum biomarkers were sampled from 47 patients who underwent stent graft repair of aortic aneurysms. Using Acute Kidney Injury Network criteria, 6 (14%) of 42 retained patients developed AKI. NGAL corrected with urine Cr (NGAL/Cr) values demonstrated the best predictive value for AKI (97% specificity, 83% sensitivity at a 65.1 μg/gCr cutoff). The area under the receiver-operator characteristic curve of NGAL/Cr value 2 h after surgery was 0.9. Although NGAL/Cr, L-FABP corrected with urine Cr (L-FABP/Cr), L-FABP, NAG, and Alb corrected by urine Cr (Alb/Cr) all reached peak values before AKI detection by sCr in AKI patients, all biomarkers reached the cutoff value before AKI detection after adaption of cutoff value. After stent graft repair of aortic aneurysm, NGAL/Cr is a potentially useful early biomarker for AKI.