Efficacy of urinary midkine as a biomarker in patients with acute kidney injury
Efficacy of urinary midkine as a biomarker in patients with acute kidney injury
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DOI：
10.1007/s10157-016-1318-0
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发表时间：
2017-08-01
影响因子：
2.3
通讯作者：
Yuzawa, Yukio
中科院分区：
文献类型：
--
作者：
Hayashi, Hiroki;Sato, Waichi;Yuzawa, Yukio
背景：尽管在干预方面取得了进展，但急性肾损伤（阿基）相关的死亡率和发病率仍然很高。中期因子（MK）是一种多功能的肝素结合生长因子，参与缺血性肾损伤的发病机制。然而，MK的临床相关性尚未阐明。本研究探讨尿MK是否可以作为一种新的生物标志物阿基.Methods我们最初比较了MK与其他尿生物标志物，包括N-乙酰-β-D-氨基葡萄糖苷酶（NAG），白细胞介素（IL）-18，NGAL的预测价值，为建立阿基（549例）的检测和鉴别诊断。随后，在40例接受择期腹主动脉瘤手术的患者中前瞻性评价了MK早期检测阿基的可靠性。分别于术前、主动脉阻断和开放时、手术结束时和术后第1天采集尿液样本。结果MK、NAG、IL-18和NGAL诊断各种肾脏疾病阿基的受试者工作特征曲线下面积分别为0.88、0.70、0.72和0.84。当尿MK的最佳临界值为11.5pg/mL时，其敏感性和特异性分别为0.87和0.85。在第二项研究中，尿MK在阿基患者的主动脉开放期间达到峰值，大约在交叉夹闭后1小时。有趣的是，MK在阿基患者的上升是非常陡峭的其他生物标志物candides. Conclusion相比，尿MK是突出的阿基的检测能力，并可能允许开始先发制人的药物治疗。
Background The mortality and morbidity associated with acute kidney injury (AKI) remains high, despite advances in interventions. A multifunctional heparin-binding growth factor, midkine (MK), is involved in the pathogenesis of ischemic kidney injury. However, the clinical relevance of MK has not yet been elucidated. The present study investigated whether urinary MK can serve as a novel biomarker of AKI.Methods We initially compared the predictive value of MK with other urinary biomarkers, including N-acetyl-beta-D-glucosaminidase (NAG), interleukin (IL)-18, and neutrophil gelatinase-associated lipocalin (NGAL), for the detection and differential diagnosis of established AKI (549 patients). Subsequently, the reliability of MK for the early detection of AKI was prospectively evaluated in 40 patients undergoing elective abdominal aortic aneurysm surgery. Urine samples were obtained at baseline, the period of aortic cross-clamping and declamping, the end of the surgery, and on post-operative day 1.Results The areas under the receiver operating characteristic curves for the diagnosis of AKI in various kidney diseases were 0.88, 0.70, 0.72, and 0.84 for MK, NAG, IL-18, and NGAL, respectively. When the optimal cutoff value of urinary MK was set at 11.5 pg/mL, the sensitivity and specificity were 0.87 and 0.85, respectively. In the second study, urinary MK peaked at the period of aortic declamping, about 1 h after cross-clamping in patients with AKI. Interestingly, the rise of MK in AKI patients was very precipitous compared with other biomarker candidates.Conclusion Urinary MK was prominent in its ability to detect AKI and may allow the start of preemptive medication.