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目的观察造影剂所致急性肾损伤(CI-AKI)进程中患者尿液Netrin-1水平的变化,探讨其对CI-AKI早期诊断的价值。方法多中心前瞻性收集197例行冠状动脉造影术(CAG)患者的临床资料,其中发生急性肾损伤(AKI)患者17例(CI-AKI组),另选取17例与CI-AKI患者临床资料匹配的非CI-AKI患者(非CI-AKI组),检测两组患者在CAG前后多个时间点的尿液Netrin-1、尿液N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、血清肌酐(sCr)、血清半胱氨酸蛋白酶抑制剂C(CysC)水平,评价尿液Netrin-1作为CI-AKI早期诊断标志物的价值。结果 CI-AKI组患者除CAG持续时间显著长于非CI-AKI组(P<0.05)外,两组间患者的一般资料、基础疾病构成、基础肾功能、实验室检查结果、术前用药情况,以及其他CAG和经皮冠状动脉介入治疗(PCI)情况的差异均无统计学意义(P值均>0.05)。CI-AKI组在CAG后2、6、12h的尿液Netrin-1水平均显著高于同组基础值(P值均<0.05),非CI-AKI组仅在CAG后6h时的尿液Netrin-1水平显著高于同组基础值(P<0.05)。CAG后2h,CI-AKI组的尿液Netrin-1水平显著高于非CI-AKI组同时间点(P<0.05),此时尿液Netrin-1水平诊断CI-AKI的ROC曲线的AUC为0.706(95%CI为0.531~0.880,P=0.040)。CI-AKI组在CAG后48、72h的sCr水平,在CAG后2、6h的尿液NAG水平均显著高于同组基础值(P值分别<0.01、0.05);非CI-AKI组在CAG后2、6、12、24h的尿液NAG水平均显著高于同组基础值(P值分别<0.01、0.05)。CI-AKI组在CAG后72h的血清CysC水平显著高于非CI-AKI组同时间点(P<0.05)。结论尿液Netrin-1水平对早期诊断CI-AKI有一定价值,sCr、尿液NAG、血清CysC水平并不适用于CI-AKI的早期诊断。
Objective To observe the change of urinary Netrin-1 in patients with contrast-induced acute kidney injury (CI-AKI) and to explore its value in the early diagnosis of CI-AKI. METHODS: A total of 197 patients with coronary artery angiography (CAG) were prospectively collected from 17 patients with acute renal injury (AKI), 17 patients (CI-AKI group) and 17 patients with CI-AKI Urine Netrin-1 and urine N-acetyl-β-D-glucosaminidase (NAG) were detected at different time points before and after CAG in the matched non-CI-AKI patients , Serum creatinine (sCr) and serum cystatin C (CysC) levels were measured to evaluate the value of urine Netrin-1 as an early diagnostic marker of CI-AKI. Results The duration of CAG in CI-AKI group was longer than that in non-CI-AKI group (P <0.05). General information, basic disease composition, basic renal function, laboratory findings, preoperative medication, There was no significant difference in other CAG and PCI (P> 0.05). Urinary Netrin-1 levels at 2, 6 and 12 h after CAG in CI-AKI group were significantly higher than those in the same group (all P <0.05) -1 level was significantly higher than the same group base (P <0.05). At 2h after CAG, the urinary Netrin-1 level in CI-AKI group was significantly higher than that in non-CI-AKI group at the same time point (P <0.05). At this time, the AUC of ROC curve of Netrin- 0.706 (95% CI 0.531-0.880, P = 0.040). The levels of sCr at 48 and 72h after CAG, and urine NAG at 2,6h after CAG in CI-AKI group were significantly higher than those in the same group (P <0.01, 0.05 respectively) Urinary NAG levels at 2, 6, 12, and 24 hours after operation were significantly higher than those in the same group (P <0.01, 0.05, respectively). The level of serum CysC at 72 hours after CAG in CI-AKI group was significantly higher than that in non-CI-AKI group at the same time point (P <0.05). Conclusion The urinary Netrin-1 level has some value in the early diagnosis of CI-AKI. The levels of sCr, urine NAG and serum CysC are not suitable for the early diagnosis of CI-AKI.