尿肝型脂肪酸结合蛋白血清胱抑素C对急性失代偿性心力衰竭患者发生急性肾损伤的预测价值

doi:10.3969/j.issn.1002-1949.2019.09.011

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摘要目的探讨血清胱抑素C（Cys C）、尿肝型脂肪酸结合蛋白(uL-FABP)对急性失代偿性心力衰竭（ADHF）患者发生急性肾损伤（AKI）提供早期诊断的价值。方法入选ADHF患者57例，入院时测血清肌酐(SCr)、Cys C、uL-FABP,并在12、24和48 h分别复测。根据AKI诊断标准分为AKI组和非AKI组。根据受试者工作特征(ROC)曲线得到12 h SCr、Cys C、uL-FABP诊断AKI的诊断界值、敏感度、特异度及ROC曲线下面积。结果 AKI组uL-FABP水平明显高于非AKI组［12 h (45.78±25.82)μg/(g·Cr) vs. (27.55±12.89)μg/(g·Cr)；24 h (57.04±25.57)μg/(g·Cr) vs. (30.47±12.97)μg/(g·Cr)；48 h (68.69±24.41)μg/(g·Cr) vs. (33.26±10.01)μg/(g·Cr)，P<0.01］，并且在12 h即升高；Cys C在24 h明显升高，两者均早于SCr的升高。ROC曲线分析表明，uL-FABP在入院12 h 时61.28 μg/(g·Cr)的截点值下，ROC曲线下面积为0.746，敏感度和特异度分别达到了80%和81%，并且随着时间的延长逐渐升高；24 h时在80.12 μg/(g·Cr)的截点值下ROC曲线下面积为0.834，敏感度达到84%，特异度达到85%；48 h时在102.30 μg/(g·Cr)的截点值下ROC曲线下面积为0.914，敏感度达到93%，特异度达到88%。24 h的Cys C的ROC曲线下面积为0.689，低于uL-FABP，SCr的ROC曲线下面积为0.503，最不敏感。结论 Cys C、uL-FABP可作为早期预测ADHF患者AKI发生的有效标志物，较传统指标SCr更早预测AKI的发生。

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	郝晓萍
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关键词 ：急性肾损伤(AKI), 急性失代偿性心力衰竭(ADHF), 胱抑素C（Cys C）, 尿肝型脂肪酸结合蛋白（uL-FABP）

基金资助:上海市静安区卫生健康委员会医学科研课题立项（2019MS06）

通讯作者: 唐琦（1970-），女，硕士，副主任医师，E-mail：tangqimed@aliyun.com。

作者简介: 郝晓萍（1972-），女，主治医师，E-mail：haoxiaoping1885@163.com。

引用本文:

郝晓萍，邬碧波，张黎明，俞华，唐琦. 尿肝型脂肪酸结合蛋白血清胱抑素C对急性失代偿性心力衰竭患者发生急性肾损伤的预测价值[J]. 中国急救医学, 2019, 39(9): 859-863.
Hao Xiao-ping, Wu Bi-bo, Zhang Li-ming, Yu Hua, Tang Qi. Investigation of urinary liver fatty acid binding protein, serum cystatin C on early diagnosis of acute kidney injury in acute decompensated heart failure patients. Chinese Journal of Critical Care Medicine, 2019, 39(9): 859-863.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.09.011 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I9/859

［1］Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2015 update: a report from the American Heart Association［J］. Circulation, 2015, 131(4): e29-e322.  ［2］Ueda T, Kawakami R, Sugawara Y, et al. Worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all-cause mortality in acute decompensated heart failure［J］. J Am Heart Assoc, 2014, 3(6): e001 174. ［3］Kazory A, Elkayam U. Cardiorenal interactions in acute decompensated heart failure: contemporary concepts facing emerging controversies［J］. J Card Fail, 2014, 20(12):1004-1011. ［4］Shlipak MG1, Matsushita K, rnlv J, et al. Cystatin C versus creatinine in determining risk based on kidney function［J］. N Engl J Med， 2013, 369(10): 932 943. ［5］徐建如，曹丝雨薇，江明．脓毒症并发急性肾损伤的早期生物标记物的研究进展［J］. 中国生化药物杂志， 2017， 37(3):27-29. ［6］Manabe K, Kamihata H, Motohiro M. et al. Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury［J］. Eur J Clin Invest, 2012, 42(5):557-563. ［7］Portilla D, Dent C, Sugaya T, et al. Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery［J］. Kidney Int, 2008,73(4):465-472. ［8］中华医学会心血管病学分会.2014中国心力衰竭诊断和治疗指南［J］. 中华心血管病杂志， 2014， 42(2):98-122. ［9］Bader FM, Attallah N. Insights into cardiorenal interactions in acute decompensated heart failure［J］. Curr Opin Cardiol, 2017, 32(2):203-208. ［10］Alge JL, Arthur JM. Biomarkers of AKI: a review of mechanistic relevance and potential therapeutic implications［J］. Clin J Am Soc Nephrol, 2015, 10(1): 147-155. ［11］Kashani K, Cheungpasitporn W, Ronco C. Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption［J］. Clin Chem Lab Med, 2017, 55(8): 1074-1089. ［12］Lassus J, Harjola VP. Cystatin-C: a step forward in assessing kidney function and cardiovascular risk［J］. Heart Fail Rev， 2012， 17(2): 251-261. ［13］Devarajan P． Neutrephil gelatinase-associated lipocalin(NGAL): a new marker of kidney disease［J］． Seand J Clin Lab Invest Suppl, 2008, 241: 89-94. ［14］Castillo-Rodriguez E, Fernandez-Prado R, Martin-Cleary C, et al. Kidney Injury Marker 1 and Neutrophil Gelatinase-Associated Lipocalin in Chronic Kidney Disease［J］. Nephron, 2017, 136(4): 263-267. ［15］袁方,刘华,王雯霞,等. 急性失代偿性心力衰竭合并急性肾损伤的早期诊断研究［J］. 上海交通大学学报(医学版)， 2014， 34(12)：1771-1779. ［16］Yang CH, Chang CH, Chen TH, et al. Combination of urinary biomarkers improves early detection of acute kidney injury in patients with heart failure［J］. Circ J, 2016, 80(4): 1017-1023.  ［17］KDIGO GROUP. KDIGO clinical practice guideline for acute kidney injury［J］. Kidney Int Suppl, 2012, 2(1): 1-138. ［18］Yamamoto T, Yamamoto A, Watanabe M, et al. Classification of FABP isoforms and tissues based on quantitative evaluation of transcript levels of these isoforms in various rat tissues［J］. Biotechnol Lett， 2009， 31(11): 1695- 1701. ［19］Kanaguchi Y, Suzuki Y, Osaki K, et al. Protective effects of L-type fatty acid-binding protein (L-FABP) in proximal tubular cells against glomerular injury in anti-GBM antibody-mediated glomerulonephritis［J］. Nephrol Dial Transplant， 2011， 26(11): 3465-3473. ［20］李易，操轩，胡亚琳，等. 尿NGAL、尿L-FABP、血清胱蛋白酶抑制剂C检测诊断早期糖尿病肾病的价值［J］. 现代中西医结合杂志， 2015， 24(32): 3604-3606. ［21］Manabe K, Kamihata H, Motohiro M, et al. Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury［J］. Eur J Clin Invest， 2012， 42(5): 557-563.  ［22］Obata Y, Kamijo-Ikemori A, Ichikawa D, et al. Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair［J］. J Anesth， 2016， 30(1): 89-99.