KIM-1检测冠脉造影后造影剂肾病的前瞻性研究

目的造影剂肾病是常见的医源性肾损伤,血肌酐是观察肾脏功能最常用指标,但是它对急性肾损伤的反应比较迟钝,而且肌酐水平受到许多因素的影响。本研究探讨KIM-1检测在诊断早期冠脉造影后出现的急性肾损伤中的意义。方法本研究前瞻性收集心内科冠脉造影69例造影剂危险积分≥6分或eGFR≤60 ml/min的高危患者,并且收录其临床资料包括既往史、病史、诊断、化验、用药记录、辅助检查结果以及冠脉造影记录。收集患者术前血、尿,术后3,6,12,24小时尿以及术后1,2,3天血,采用ELISA法测定69例行冠脉造影的高危患者术后尿KIM-1水平,并与血肌酐进行相关分析,了解其诊断CIN的特异度以及灵敏度。结果 Pearson检验结果提示术前术后KIM-1(R=0.230、P=0.049)变化与肌酐变化呈直线正相关。在诊断CIN上,NGAL的特异度为95.2%,敏感度为75%。结论在急性肾损伤新型生物指标中,KIM-1是比较好的指标,能较早诊断CIN。

Prospective Study of Monitoring of Kidney Function by Kidney Injury Molecule-1 in Patients with Contrast Induced Nephropathy after Coronary Angiography

Objective To explore the effect of monitoring the kidney function by kidney injury molecule-1(KIM-1) on the early diagnosis of contrast induced nephropathy(CIN) after the coronary angiography(CAG).Methods The clinical data such as past and present history,diagnosis,laboratory result,drug usage,result from cardio-echogram and DSA were collected in 69 CAG/PCI patients with CIN risk score≥6 or eGFR≤60 ml/min.The urine samples were collected before the procedure and on 3,6,12 and 24 hours after the operation;while the blood samples were collected before the procedure and on d1,d2 and d3 after the operation.KIM-1 levels in urine were tested by ELISA,and its correlation with the levels of serum creatinine(SCr) was analyzed by Pearson’s correlation.Results The level of KIM-1 before and after CAG positively correlated with SCr by the linear relationship.In diagnosing CIN,the specificity and sensitivity of KIM-1 has a specificity of 95.2% and sensitivity of 75%.Conclusion KIM-1 is a better biomarker in terms of early diagnosis of CIN.