探讨三种检测指标对婴幼儿心脏手术后急性肾损伤的早期价值OA
Predictive value of three detection indicators for acute kidney injury after cardiac sur-gery in infants and young children
目的 探讨Dickkopf相关蛋白3(DKK3)、金属蛋白酶组织制剂2(TIMP-2)及人胰岛素样生长因子结合蛋白7(IGFBP7)三种检测指标对婴幼儿接受体外循环(CPB)心脏手术后发生急性肾损伤(AKI)的早期诊断价值.方法 选取2020-12至2022-04在解放军总医院第七医学中心接受心脏手术的患儿50例,根据国际肾病改善全球预后组织(KDIGO)标准将患儿分为AKI组和非AKI组,比较两组术前、CPB后3h、24h尿液中DKK3和[TIMP-2]×[IGFBP7]浓度.采用受试者工作特征曲线(ROC)评价对术后AKI的诊断价值.结果 与非AKI组比较,AKI组术前DKK3水平及CPB后3、24h[TIMP-2]×[IGFBP7]水平均显著升高.Logistic回归分析显示,术前DKK3水平(OR=26.32,95％CI:1.75～396.30,P=0.018)、CPB后3h[TIMP-2]×[IGFBP7](OR=1.22,95％CI:1.03～1.43,P=0.022)和24 h[TIMP-2]×[IGFBP7](OR=1.16,95％CI:1.02～1.31,P=0.021)为心脏手术后AKI的独立危险因素.AUC分析进一步证实,术前DKK3(AUC=0.75)、CPB后3 h(AUC=0.77)、24 h[TIMP-2]×[IGFBP7](AUC=0.75)具有较高预测准确性.特定阈值分析表明,当术前DKK3<1.89 ng/ml及CPB后3h、24h[TIMP-2]×[IGFBP7]<0.32(ng/ml)2/1000时,AKI发生风险显著降低.结论 尿DKK3和[TIMP-2]×[IGFBP7]可作为中国婴幼儿心脏手术后AKI早期检测的有价值的生物标志物.
Objective To explore the early diagnostic value of Dickkopf-associated protein 3(DKK3)tissue preparation of metalloproteinase 2(TIMP-2),and human insulin-like growth factor binding protein 7(IGFBP7)for acute kidney injury(AKI)in in-fants and young children after cardiopulmonary bypass(CPB)cardiac surgery.Methods A total of 50 children who underwent car-diac surgery at the Seventh Medical Center of PLA General Hospital from December 2020 to April 2022 were selected,and divided into the AKI group and the non-AKI group according to the criteria of the International Group for Improving Global Prognosis of Ne-phrology(KDIGO).The concentrations of DKK3 and[TIMP-2]•[IGFBP7]in the urine of the two groups before the operation,3 hours after CPB,and 24 hours after CPB were compared.The diagnostic value of postoperative AKI was evaluated by using the re-ceiver operating characteristic curve(ROC).Results Compared with the non-AKI group,the preoperative DKK3 levels and the lev-els of TIMP-2]•[IGFBP7]at 3 and 24h after CPB were significantly increased in the AKI group.Logistic regression analysis showed that the preoperative DKK3(OR=26.32,95%CI:1.75～396.30,P=0.018),and[TIMP-2]•[IGFBP7]at 3h after CPB(OR=1.22,95%CI:1.03～1.43,P=0.022)and 24h after CPB(OR=1.16,95%CI:1.02～1.31,P=0.021)were independent risk factors for AKI after cardiac surgery.The ROC analysis further confirmed that the preoperative DKK3(AUC=0.75),[TIMP-2]•[IGFBP7]at 3h af-ter CPB AUC=0.77)and 24h after CPB(AUC=0.75)had relatively high predictive value.Specific threshold analysis indicated that when preoperative DKK3 was less than 1.89 ng/ml and[TIMP-2]•[IGFBP7]was<0.32(ng/ml)2/1000 at 3 h and 24 h after CPB,the risk of AKI was significantly reduced.Conclusions Urinary DKK3 and TIMP-2]•[IGFBP7]serve as valuable biomarkers for the early detection of AKI after cardiac surgery in Chinese infants and young children.
范春玲;郭文治;刘永哲
100144,北京大学首钢医院麻醉科100007 北京,解放军总医院第七医学中心麻醉科100039 北京,解放军总医院第三医学中心麻醉科
临床医学
Dickkopf相关蛋白3金属蛋白酶组织制剂2人胰岛素样生长因子结合蛋白7急性肾损伤体外循环婴幼儿
DKK3TIMP-2IGFBP7acute kidney injurycardiopulmonary bypassinfants and young children
《武警医学》 2025 (5)
388-393,398,7
首都卫生发展科研专项项目(2020-2-5092)
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