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JACC:尿透明质酸是心脏手术相关急性肾损伤早期预测因子

2014-09-08 iang 丁香园

心脏手术相关急性肾损伤(Cardiac surgery-associated acute kidney injury,CSA-AKIA)是体外循环下行心脏手术患者的一个常见且复杂的临床问题,也是心脏手术后伤残和死亡的重要预测因子。根据血清肌酐水平和/或尿量改变等现行共识标准,CSA-AKI只有在术后24-48小时才能被诊断。尽管CSA-AKI治疗措施有限,但尽早预防进一步损害和及时预测对改善预后至

心脏手术相关急性肾损伤(Cardiac surgery-associated acute kidney injury,CSA-AKIA)是体外循环下行心脏手术患者的一个常见且复杂的临床问题,也是心脏手术后伤残和死亡的重要预测因子。

根据血清肌酐水平和/或尿量改变等现行共识标准,CSA-AKI只有在术后24-48小时才能被诊断。尽管CSA-AKI治疗措施有限,但尽早预防进一步损害和及时预测对改善预后至关重要。

虽然研究不断发现新的生物标志物(如尿白介素-18,尿NGAL或尿KIM-1),但这些标志物对于预测CSA-AKI而言并非最佳。透明质酸(HA)是包括肾脏在内的许多器官细胞外基质的重要结构组成成分,其介导的细胞和器官功能亦是非常广泛,因此,HA成为AKI领域的研究热点。

本研究旨在探索尿HA(uHA)浓度与当前采用的临床指标相比,是否能更早地预测CSA-AKI。为此,我们纳入55名高危CSA-AKI患者(Cleveland Clinic评分≥6,该评分由患者特征、合并症、手术类型等13中术前危险因素组成)。研究主要终点为发生CSA-AKI(采用KDIGO标准)。

研究结果表明26名患者发生AKI。未发生CSA-AKI的患者术后uHA浓度无显著上升,相反,发生CSA-AKI的患者uHA浓度显著上升,并且在术后4开始上升,持续是术后24小时。根据血肌酐标准化uHA后,趋势仍保持不变。

肾透明质酸在糖尿病和肾结石等慢性疾病中表达增加,也可能导致慢性肾功能不全,另外,糖尿病和术前肾功能不全均增加CSA-AKI风险。我们的研究人群中uHA基线浓度并未在糖尿病或术前肾功能不全患者中升高,说明uHA可作为AKI标志物,但AKI中uHA浓度上升原因尚不明确。

为了检测uHA能否预测CSA-AKI,我们计算了ROC曲线下面积,体外循环4小时、12小时和24小时后uHA曲线下面积分别为0.89、0.94和0.89。uHA曲线下面积明显大于血肌酐和尿量,表明uHA预测诊断能力更强。术后12小时uHA浓度>400 ng/ml的患者发生CSA-AKI的风险是浓度<400 ng/ml的6.8倍。

将糖尿病、射血分数、体外循环以及慢性肾脏病等7个临床特征作为协变量进行Cox风险比例回归分析时,uHA仍与AKI关系密切。

该研究为首个描述uHA作为CSA-AKI早期生物标志物的研究。我们的研究发现在发生CSA-AKI的患者中,uHA浓度在建立体外循环后4小时开始升高,而uHA在未发生AKI患者中保持不变。曲线下面积>0.9也意味着uHA预测价值高于其它标志物。另外,我们的研究还发现uHA不受患者异质性合并症的影响。

本研究也存在一定的局限,最重要的是,本研究仅纳入了少量CSA-AKI高危患者,需要大型多中心研究来证实我们的研究结论。

总而言之,我们的初步研究表明尿透明质酸或可成为早期预测CSA-AKI强有利的生物标志物。

原始出处:
Zarbock A, Meersch M, Van Aken H, Görlich D, Singbartl K.Urinary hyaluronic Acid as an early predictor of acute kidney injury after cardiac surgery. J Am Coll Cardiol. 2014 Aug 19;64(7):737-8

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    2015-08-01 sundong

    这还有争议

    0

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    2015-08-11 hbwxf
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    2014-09-10 仁医06
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    2014-09-08 kidney

    uHA早到什么程度?

    0

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