上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

急性失代偿性心力衰竭合并急性肾损伤的早期诊断研究

袁 方，刘 华，王雯霞，戴锦杰，戴丽莹，杨潇潇，方唯一   

  1. 上海交通大学附属胸科医院心内科， 上海 200030
  • 出版日期:2014-12-28 发布日期:2014-12-30
  • 作者简介:袁 方（1969—）， 女， 主任医师， 硕士， 硕士生导师; 电子信箱: yuanfangysh@126.com。
  • 基金资助:

    上海市卫生局科研项目（20114324）

Study on early diagnosis of acute decompensated heart failure combined with acute renal injury

YUAN Fang, LIU Hua, WANG Wen-xia, DAI Jin-jie, DAI Li-ying, YANG Xiao-xiao, FANG Wei-yi   

  1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Online:2014-12-28 Published:2014-12-30
  • Supported by:

    Science and Technology Foundation of Shanghai Municipal Health Bureau, 20114324

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摘要：

目的 评价新型急性肾损伤（AKI）的生物标志物对急性失代偿性心力衰竭（ADHF）合并AKI即1型心肾综合征(CRS1)的早期诊断价值。方法 入选ADHF患者200例，测基线血清肌酐(Scr)、血清组合[中性粒细胞明胶酶相关脂质运载蛋白（NAGL）、胱蛋白酶抑制剂C （Cys C）]、尿液组合[（NAGL、肾损伤分子1 (KIM-1) ]，6 h和18 h分别复测血清组合和尿液组合，48 h后复测Scr。根据CRS1诊断标准筛选出CRS1患者，分析血清及尿液NAGL、血清Cys C、尿液KIM1与Scr的相关性；根据受试者工作特征（ROC）曲线得到6 h和18 h时NAGL、Cys C、KIM-1诊断AKI的诊断界值、灵敏度、特异度及ROC曲线下面积（AUC）；分别计算6 h和18 h血清组合（NAGL、Cys C）、尿液组合（NAGL、KIM-1）检测AKI的AUC。结果 根据CRS1的诊断标准，200例ADHF患者中48例发生AKI，发生率为24%。6 h血清NAGL、18 h血清Cys C分别与Scr呈正相关（r＝0.857，P<0.05；r＝0.869，P<0.05）；6 h尿液NAGL、KIM-1与Scr呈正相关(r＝0.756，P<0.05；r＝0.742, P<0.05)。联合检测6 h和18 h血清组合的AUC为0.87和0.89；联合检测6 h和18 h 尿液组合的AUC为0.92和0.93。结论 血清、尿液NAGL及血清Cyc C、尿液KIM-1可作为CRS1患者的早期诊断标志物；联合检测尿液NAGL和KIM-1可提高CRS1早期诊断的敏感度和特异度。

关键词: 急性失代偿性心力衰竭, 急性肾损伤, 血清肌酐, 中性粒细胞明胶酶相关脂质运载蛋白, 胱蛋白酶抑制剂C, 肾脏损伤分子1

Abstract:

Objective To evaluate the value of new biological indicators of acute kidney injury (AKI) for early diagnosis of acute decompensated heart failure (ADHF) combined with AKI, i.e. cardiorenal syndrome type 1 (CRS1). Methods A total of 200 patients with ADHF were enrolled. Levels of baseline serum creatinine (SCr), serum combination [neutrophil gelatinase associated lipocalin (NAGL) and Cystatin C (CysC)], and urine combination [NAGL and kidney injury molecule-1(KIM-1)] were detected. Levels of serum combination and urine combination were redetected after 6 h and 18 h and the level of SCr was redetected after 48 h. According to the criteria, CRS1 patients were selected. The correlations of serum and urine NAGL, serum CysC, urine KIM-1, and Scr were analyzed. According to receiver operating characteristic (ROC) curve, the cut-off value, sensitivity, specificity, and the area under the ROC curve (AUC) of NAGL, Cys C and KIM-1 at 6 h and 18 h for diagnosing AKI were obtained. The AUC of serum combination (NAGL,Cys C) and urine combination (NAGL，KIM-1) at 6 h and 18 h for diagnosing AKI was calculated. Results According to the diagnostic criteria of CRS1, 48 of 200 ADHF patients were diagnosed with AKI and the incidence was 24%. Serum NAGL at 6 h and serum Cys C at 18 h positively correlated with Scr (r＝0.857, P<0.05; r＝0.869, P<0.05). Urine NAGL and KIM-1 at 6 h positively correlated with Scr (r＝0.756, P<0.05； r＝0.742, P<0.05). The AUCs of serum combination at 6 h and 18 h were 0.87 and 0.89, while the AUCs of urine combination at 6 h and 18 h were 0.92 and 0.93. Conclusion Serum and urine NAGL, serum Cys C, and urine KIM-1 can be used as early diagnostic indicators for CRS1 patients. Combined detection of urine NAGL and KIM-1 may improve the sensitivity and specificity of early diagnosis of CRS1.

Key words: acute decompensated heart failure, acute renal injury, serum creatinine, neutrophil gelatinase associated lipocalin, Cystatin C, kidney injury molecule-1