Urine Neutrophil Gelatinase-Associated Lipocalin and Interleukin-18 Predict Acute Kidney Injury after Cardiac Surgery
Urine Neutrophil Gelatinase-Associated Lipocalin and Interleukin-18 Predict Acute Kidney Injury after Cardiac Surgery
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DOI：
10.1080/08860220802359089
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发表时间：
2008-01-01
期刊：
影响因子：
3
通讯作者：
Mu Xinwei
中科院分区：
文献类型：
--
作者：
Chen Xin;Xiao Yulong;Mu Xinwei
背景资料。心脏手术后约有30-50%的患者发生急性肾损伤(AKI)，临床上仍以血肌酐作为诊断指标。然而，血清肌酐的升高是不敏感的和延迟的。本研究的目的是验证中性粒细胞明胶酶相关脂钙蛋白(NGAL)和白介素18(IL-18)是心脏手术后AKI的早期生物标志物的假设。方法：研究方法。心内直视手术患者33例，按急性肾损伤定义分为急性肾损伤组和非急性肾损伤组。急性肾损伤分为急性肾损伤组和非急性肾损伤组，按急性肾损伤的定义分为急性肾损伤组和非急性肾损伤组，每小时血肌酐升高26.5mU/L，48小时内血肌酐升高50%以上，或尿量下降0.5毫升/公斤，持续6小时以上。测定不同时间点的血NGAL、尿NGAL、尿IL-18浓度。结果。术后发生AKI 9例(27.27%)，但血肌酐确诊时间为术后12~48h。术后血清NGAL浓度无明显升高。AKI组尿NGAL、IL-18水平明显升高，术后2~4h达高峰，经尿肌酐校正后差异有统计学意义。术后2 h尿NGAL和IL-18浓度，无论是否经尿肌酐校正，均具有良好的敏感性和特异性。术后2 h尿NGAL和IL-18水平升高与术后12 h血肌酐水平升高呈正相关。Logistic回归分析显示，校正后的术后2 h尿NGAL和术后2 h的尿IL-18是心脏术后AKI的独立预测因素。结论。尿NGAL和IL-18浓度可作为心脏手术后AKI的有用生物标志物，尤其是在尿肌酐校正后。
Background. About 30-50% patients develop acute kidney injury (AKI) after cardiac surgery, which is still diagnosed by serum creatinine on clinic. However, the increase of serum creatinine is insensitive and delayed. The aim of this study is to test the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are early biomarkers for AKI in patients after cardiac surgery. Methods. Thirty-three cases undergoing cardiac surgery were classified into an AKI group and non-AKI group, according to the AKI definition (> 26.5 mu ol/L increase of serum creatinine, more than or equal to 50% increase of serum creatinine within 48 h, or a reduction in urine output < 0.5 mL/Kg per hour for more than six hours). The concentrations of serum NGAL, urine NGAL, and urine IL-18 at different time-points were measured. Results. Nine cases (27.27%) developed postoperative AKI, but diagnosis with serum creatinine was 12-48 h postoperation. The concentrations of serum NGAL were not significantly increased postoperation. The concentrations of urine NGAL and IL-18 were significantly increased in the AKI group, which reached the peak at 2-4 h postoperation, and a more significant difference could be seen after correction for urine creatinine. The concentrations of urine NGAL and IL-18 2 h postoperation, either corrected for urine creatinine or not, showed good sensitivity and specificity. Increased levels of urine NGAL and IL-18 2 h postoperation were significantly correlated with increased level of serum creatinine 12 h postoperation. Logistic regression analysis showed that urine NGAL corrected for urine creatinine 2 h postoperation and urine IL-18 2 h postoperation emerged as powerful independent predictors of AKI after cardiac surgery. Conclusions. The concentrations of urine NGAL and IL-18 could be useful biomarkers for AKI in patients after cardiac surgery, especially after correction for urine creatinine.