Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery
Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery
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DOI：
10.1097/00000542-200609000-00011
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发表时间：
2006-09-01
期刊：
影响因子：
8.8
通讯作者：
Lee, H. Thomas
中科院分区：
文献类型：
--
作者：
Wagener, Gebhard;Jan, Michael;Lee, H. Thomas
背景。心脏手术后的急性肾功能障碍（ARD）以及随后的急性肾衰竭与高死亡率和发病率相关。由于缺乏急性肾损伤的早期生物标志物，早期治疗或预防性干预受到阻碍。近期研究表明，在小鼠肾损伤后以及心脏手术后的儿童ARD中，尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL或脂质运载蛋白2）早期（1 - 3小时内）上调。作者假设与未发生ARD的患者相比，心脏手术后发生ARD的成年患者术后尿NGAL浓度升高。
方法：经机构审查委员会批准，对81例心脏手术患者进行了前瞻性研究。在手术切皮前即刻以及术后不同时间间隔采集尿液样本，通过定量免疫印迹法分析NGAL。ARD定义为术后血清肌酐峰值较术前血清肌酐升高50%或更多。
结果：81例患者中有16例（20%）发生术后ARD，发生ARD的患者术后早期平均尿NGAL浓度显著高于未发生ARD的患者（1小时后：4195 ± 6520[均值±标准差]对1068 ± 2129 ng/ml；P < 0.01）。发生ARD的患者在心脏手术后3小时和18小时平均尿NGAL浓度持续升高且仍显著高于未发生ARD的患者。相反，未发生ARD的患者在心脏手术后尿NGAL迅速下降。
结论：术后发生ARD的患者在心脏手术后早期尿NGAL浓度显著升高。因此，尿NGAL可能是心脏手术后ARD的一种有用的早期生物标志物。这些发现可能有助于急性肾损伤的早期检测，并有可能防止进展为急性肾衰竭。
Background. Acute renal dysfunction (ARD) and subsequent acute renal failure after cardiac surgery are associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of an early biomarker for acute renal injury. Recent studies showed that urinary neutrophil gelatinase-associated lipocalin (NGAL or lipocalin 2) is up-regulated early (within 1-3 h) after murine renal injury and in pediatric ARD after cardiac surgery. The authors hypothesized that postoperative urinary NGAL concentrations are increased in adult patients developing ARD after cardiac surgery compared with patients without ARD.Methods: After institutional review board approval, 81 cardiac surgical patients were prospectively studied. Urine samples were collected immediately before incision and at various time intervals after surgery for NGAL analysis by quantitative immunoblotting. ARD was defined as peak postoperative serum creatinine increase by 50% or greater compared with preoperative serum creatinine.Results: Sixteen of 81 patients (20%) developed postoperative ARD, and the mean urinary NGAL concentrations in patients who developed ARD were significantly higher early after surgery (after 1 h: 4,195 +/- 6,520 [mean +/- SD] vs. 1,068 +/- 2,129 ng/ml; P < 0.01) compared with patients who did not develop ARD. Mean urinary NGAL concentrations continued to increase and remained significantly higher at 3 and 18 h after cardiac surgery in patients with ARD. In contrast, urinary NGAL in patients without ARD decreased rapidly after cardiac surgery.Conclusions: Patients developing postoperative ARD had significantly higher urinary NGAL concentrations early after cardiac surgery. Urinary NGAL may therefore be a useful early biomarker of ARD after cardiac surgery. These findings may facilitate the early detection of acute renal injury and potentially prevent progression to acute renal failure.