摘要目的 观察联合检测尿液中的中性粒细胞明胶酶相关载脂蛋白(NGAL)、肾脏损伤分子-1(KIM-1)及白细胞介素18(IL-18)水平对早期诊断对比剂肾病(CIN)的价值.方法 选取2015年5月至2017年2月在苏州市立医院北区行颅脑血管成像使用碘对比剂的367例患者.其中31例患者据2011年欧洲泌尿放射学会制订的CIN诊断标准,可诊断为CIN,作为CIN组.在非CIN患者中随机选取30例,作为非CIN组.随机选取同期在本院住院而未使用造影剂的30例患者作为对照组,入院后留取尿液及血液标本,进行血肌酐(Scr)、尿NGAL、尿KIM-1、尿IL-18的检测.造影组患者均留取造影前、造影后8、24及72 h的尿液及血液标本,检测各时间点的Scr、尿NGAL、尿KIM-1、尿IL-18水平.通过比较使用对比剂前后各项生物学指标的变化、绘制受试者工作特征(ROC)曲线及曲线下面积(AUC)来评估联合尿NGAL、KIM-1及IL-18对诊断CIN的敏感度及特异度及其在CIN早期诊断方面的价值.结果 (1)367例患者中31例诊断为CIN,CIN发生率为8.4％.(2)与非CIN组相比,CIN组患者的尿NGAL、KIM-1及IL-18水平均在造影后8h出现显著升高(P＜0.05).(3)ROC曲线分析发现:联合尿NGAL、KIM-1及IL-18三种生物学指标来早期诊断CIN,则造影后8h的AUC、敏感度及特异度分别为0.999、96.8％、100％,造影后24h及72 h的ROC曲线下面积均高达1.0,且敏感度及特异度均为100％.结论 (1)尿NGAL、KIM-1及IL-18水平均在CIN早期即出现显著升高,较血肌酐升高明显提早.(2)尿NGAL、KIM-1及IL-18在早期诊断CIN的敏感度及特异度方面较传统指标血肌酐存在优势,尤以联合检测尿中NGAL、KIM-1及IL-18在早期诊断的敏感度及特异度方面价值更高,可以作为CIN早期诊断的指标.

abstractsObjective To investigate the significance of combined detection of urine neutrophil gelatinase-associated lipocalin (NGAL),kidney injury molecule-1 (KIM-1),and interleukin-18 (IL-18) in early diagnosis of contrast-induced nephropathy (CIN).Methods A total of 367 hospitalized patients undergone CT angiography (CTA) was enrolled into this study from May 2015 to February 2017.According to the European Society of Urology and radiology (ESUR) guidelines 2011,CIN was diagnosed in 31 patients (CIN group),and a total of 30 non CIN patients were randomly selected as non-CIN group.Another 30 patients who were hospitalized during the same period without contrast media were randomly selected as the control group.The changes of serum creatinine (Scr),urinary NGAL,KIM-1,and IL-18 were detected before and 8 h,24 h and 72 h after CTA.The same serum and urinary samples were collected at the time of admission in the control group.The sensitivity and specificity values of combined urinary NGAL,KIM-1,and IL-18 in early diagnosis CIN were evaluated by the under area of the receiver operating characteristic curves and area under curve (AUC).Results (1) According to ESUR guidelines 2011,CIN was diagnosed in 31 patients (8.4％).(2) At 8h after CTA,the levels of urinary NGAL,KIM-1,and IL-18 were significantly increased in the CIN group,compared with non-CIN group (P ＜ 0.05).(3) The AUC,sensitivity and specificity for early diagnosis of CIN were 0.999,96.8％,and 100％,when combine urinary NGAL,KIM1,and IL-18,at 8h after CTA.AUC for 24 h,and 72 h after contrast media injection approach to 1.0,at this time sensitivity and specificity were 100％,and 100％,respectively.Conclusions (1) At 8 h after CTA,the urinary NGAL,KIM-1,and IL-18 levels were significantly increased in the CIN group.(2) The predictable time of CIN onset determined by urinary NGAL,KIM-1,and IL-18 was earlier than Scr,and the sensitivity and specificity is higher in these biomarkers than Scr in early diagnosis of CIN.Especially combination of urinary NGAL,KIM-1,and IL-18 is more valuable in predicting the sensitivity and specificity of the diagnosis,and can be used as an indicator for early diagnosis of CIN.