尿L-FABP与尿NGAL联合应用在儿童心脏术后急性肾损伤早期诊断中的价值

Values of combination of urinary L-FABP and NGAL in early diagnosis of acute kidney injury after cardiac surgery in children

摘要:

目的 探讨尿肝型脂肪酸结合蛋白（L-FABP）与尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）联合应用在儿童心脏术后急性肾损伤（AKI）早期诊断中的价值。方法 以需建立体外循环（CPB）的97例先天性心脏病儿童为研究对象，收集其心脏手术前及术后不同时间点的血尿标本，分别测定血清肌酐（Scr）、尿L-FABP和尿NGAL水平，并比较AKI组（n=18）和非AKI组（n=79）患儿术后各标志物的动态变化。应用受试者工作特征（ROC）曲线及曲线下面积（AUC）评估标志物单独及其联合应用在预测术后AKI发生中的作用。结果 AKI组患儿尿L-FABP和尿NGAL水平在术后2 h、6 h均显著高于非AKI组，其浓度变化明显早于Scr的升高。尿L-FABP在术后2 h、6 h单独预测AKI发生的AUC分别为0.921和0.896；尿NGAL在术后2 h、6 h单独预测AKI发生的AUC分别为0.908和0.928。术后2 h及6 h尿L-FABP及NGAL联合应用预测术后AKI发生的AUC分别为0.942和0.929。结论 尿L-FABP和尿NGAL在儿童心脏术后AKI早期即显著升高，明显早于Scr的改变，可早期预测AKI的发生，而两者联合应用可使诊断的精确性进一步提高。

Abstract:

Objective To investigate the values of combination of urinary liver-type fatty acid-binding protein (L-FABP) and neutrophil gelatinase-associated lipocalin (NGAL) in early diagnosis of acute kidney injury (AKI) after cardiac surgery in children. Methods A total of 97 children with congenital heart disease undergoing cardiopulmonary bypass surgery were enrolled. Serum and urine samples were collected before and after surgery. Levels of serum creatinine (Scr), urinary L-FABP, and urinary NGAL from AKI group (n=18) and non-AKI group (n=79) were measured, and the postoperative dynamic changes in these markers were compared between the two groups. The receiver operating characteristic (ROC) curve and the area under ROC curve (AUC) were used to assess the values of these markers alone or in combination in the prediction of postoperative AKI. Results The levels of urinary L-FABP and NGAL in the AKI group were signifcantly higher than those in the non-AKI group at 2 and 6 hours after surgery, and the changes in their concentrations were earlier than Scr. The AUCs of urinary L-FABP alone in predicting AKI at 2 and 6 hours after surgery were 0.921 and 0.896 respectively, and those of urinary NGAL alone were 0.908 and 0.928 respectively. Those of their combination were 0.942 and 0.929 respectively. Conclusions Urinary L-FABP and NGAL signifcantly increase in the early stage of AKI after cardiac surgery in children, which are signifcantly earlier than the changes in Scr. They can be used to predict the occurrence of AKI in the early stage. A combination of the two biomarkers can further improve the accuracy of diagnosis.