尿肾损伤分子―1检测对造影剂肾病早期诊断临床意义.docVIP

尿肾损伤分子―1检测对造影剂肾病早期诊断临床意义 　　[摘要] 目的 探讨冠脉造影后患者的尿肾损伤分子-1（KIM-1）浓度对造影剂肾病早期诊断的临床意义。 方法 选取复旦大学附属中山医院青浦分院2014年4月～2015年5月行冠脉造影术及PCI术患者179例，用苦味酸速率法检测术前24 h内及术后24、48、72 h时血清肌酐（Scr）的浓度，用ELISA法检测术前及术后2、6、12、24、48、72 h时尿KIM-1的浓度，所有患者用非离子型低渗造影剂。根据造影剂肾病（CIN）诊断标准，将以上患者分为CIN组和非CIN组。 结果 CIN组17例，非CIN组162例，CIN总发生率为9.49%；CIN组，尿KIM-1在术后2 h开始升高，24 h达高峰，48 h开始下降，与术前比较差异有统计学意义（P 0.05）。 结论 在造影剂肾病中，尿KIM-1浓度的变化早于Scr，可能作为其早期诊断的一种新的标志物。 　　[关键词] 造影剂肾病；肾损伤分子-1；冠脉造影；经皮冠状动脉治疗术 　　[中图分类号] R692.9 [文献标识码] A [文章编号] 1673-7210（2016）05（c）-0173-04 　　[Abstract] Objective To explore the effect of monitoring the kidney function by kidney injury molecule-1 （KIM-1） on early diagnosis of contrast induced nephropathy （CIN） after the coronary angiography（CAG）. Methods From April 2014 to May 2015， in Qingpu Branch Hospital of Zhongshan Hospital， the clinical data of 179 patients with CAG/PCI were collected. The blood samples were collected before the procedure within 24 h and at 24， 48， 72 h after the operation， while the urine samples were collected before the procedure and at 2， 6， 12， 24， 48， 72， 48 h after the operation. Scr levels in blood were tested by picric acid rate method； KIM-1 levels in urine were tested by ELISA. The patients were divided into CIN group and non-CIN group according to the diagnostic criteria of CIN. Results The CIN group had 17 patients， and the non-CIN group had 162 patients， the incidence rate of CIN was 9.49%. In CIN group， KIM-1 levels in urine began to rise at 2 h after the operation， reached the peak level at 24 h， and decreased at 48 h， compared with that before the operation， the differences were statistically significant （P 0.05）. Conclusion To compare with Scr， KIM-1 is a better biomarker in terms of early diagnosis of CIN. 　　[Key words] Contrast induced nephropathy； Kidney injury molecule-1； Coronary angiography； Percutaneous coronary therapy 　　近几十年来，随着放射诊断技术和介入治疗的发展，人口老龄化，接受造影剂的高龄患者中合并心、脑、肾病变，造影剂肾病（contrast induced nephropathy，CIN）已成为医院获得性急性肾损伤（AKI）的第三大病因[1]，高危人群中发生率