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目的:检测慢性心力衰竭(心衰)患者尿液肾损伤分子-1(KIM-1)的水平,探讨KIM-1水平与心功能、心衰严重程度、肾功能之间的关系。方法:选取慢性心衰患者60例为慢性心衰组,对照组为我院体检中心的健康对照者30例。所有入选者均行左室射血分数(EF),肾小球滤过率(eGFR),血浆N端B型脑钠肽前体(NTpro-BNP),尿白蛋白排泄率(ACR)和KIM-1检测。结果:与对照组相比,慢性心衰组患者尿KIM-1水平显著升高(P<0.05)。将患者按EF≥40%和EF<40%分组发现,EF<40%组患者尿KIM-1水平显著高于EF≥40%组(P<0.05),2组均显著高于对照组(P<0.05)。另外,研究发现尿KIM-1水平与NT-pro-BNP水平呈正相关(r=0.45,P<0.05);与EF呈负相关(r=-0.38,P<0.05),慢性心衰组患者尿KIM-1水平与Scr无显著相关性(r=0.11,P>0.05);与eGFR无显著相关性(r=-0.13,P>0.05)。尿KIM-1水平与ACR水平显著正相关(r=0.42,P<0.05)。结论:肾功能正常的慢性心衰患者尿KIM-1水平显著升高,与心功能和心衰的严重程度密切相关。提示慢性心衰患者存在肾小管损伤,并且尿KIM-1水平可以间接反映慢性心肾综合征的严重程度。
Objective: To detect the level of urine nephrotoxic molecule-1 (KIM-1) in patients with chronic heart failure (CHF) and to explore the relationship between KIM-1 level and heart function, severity of heart failure and renal function. Methods: Sixty chronic heart failure patients were selected as the chronic heart failure group, and the control group was 30 healthy controls in the physical examination center of our hospital. All participants underwent EF, GFR, NTpro-BNP, ACR and KIM -1 test. Results: Compared with the control group, urinary KIM-1 levels in patients with chronic heart failure were significantly increased (P <0.05). According to the group of EF≥40% and EF <40%, the urinary KIM-1 level in EF <40% group was significantly higher than that in EF≥40% group (P <0.05), the two groups were significantly higher than the control group (P <0.05). In addition, urine KIM-1 levels were positively correlated with NT-pro-BNP levels (r = 0.45, P <0.05), negatively correlated with EF (r = -0.38, There was no significant correlation between KIM-1 level and Scr (r = 0.11, P> 0.05). There was no significant correlation between KIM-1 and eGFR (r = -0.13, P> 0.05). There was a significant positive correlation between urine KIM-1 level and ACR level (r = 0.42, P <0.05). CONCLUSIONS: Urinary KIM-1 levels are significantly elevated in patients with chronic heart failure with normal renal function and are closely related to the severity of heart function and heart failure. It is suggested that renal tubular injury exists in patients with chronic heart failure, and urine KIM-1 level may indirectly reflect the severity of CHD.