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目的探讨尿肾损伤分子-1(kidney injury molecule-1,Kim-1)及尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acecyl-β-D-glucosaminidase,NAG)在成人心脏手术后急性肾损伤(acute kidney injury,AKI)中的敏感性及诊断价值。方法行心脏手术患者105例,根据AKI诊断标准分为AKI组65例与非AKI组40例,检测2组手术前、手术后24,48,72h尿Kim-1,NAG及血肌酐水平,并以ROC曲线及AUC评价各项指标诊断AKI的敏感性。结果 2组术前血肌酐、尿Kim-1及尿NAG水平比较差异均无统计学意义(P>0.05);术后不同时间点AKI组血肌酐、尿Kim-1及尿NAG水平较非AKI组明显升高(P<0.001);联合检测尿Kim-1及尿NAG最佳诊断时间点为48h,AUC为0.912(95%CI:0.786～0.939)。结论尿Kim-1及尿NAG联合检测可作为成人心脏手术后AKI早期诊断的指标,对预防AKI发生、发展有重要价值。
Objective To investigate the effects of kidney injury molecule-1 (Kim-1) and urine N-acecyl-β-D-glucosaminidase (NAG) Sensitivity and diagnostic value in acute kidney injury (AKI). Methods A total of 105 patients undergoing cardiac surgery were divided into AKI group (65 cases) and non-AKI group (40 cases) according to the criteria of AKI. Urinary Kim-1, NAG and serum creatinine were measured before and 24 hours, 48 hours and 72 hours after operation The ROC curve and AUC were used to evaluate the sensitivity of AKI. Results The serum creatinine, urinary Kim-1 and urinary NAG levels were not significantly different between the two groups (P> 0.05). The levels of serum creatinine, urinary Kim-1 and urine NAG in AKI group were significantly higher than those in non-AKI group (P <0.001). The best time for diagnosis of urinary Kim-1 and urinary NAG was 48h, the AUC was 0.912 (95% CI: 0.786-0.939). Conclusion Combined detection of urinary Kim-1 and urinary NAG can be used as an index for the early diagnosis of AKI after cardiac surgery in adults and is of great value in preventing the occurrence and development of AKI.