Semaphorin 3A早期诊断对比剂急性肾损伤的价值

doi:10.3969/j.issn.1673-8640.2018.011.007

摘要/Abstract

摘要：

目的探讨Semaphorin（Sema）3A在对比剂急性肾损伤（CIAKI）中的早期诊断价值。方法将行冠状动脉造影及支架植入术的350例患者分为2组：CIAKI组46例、非CIAKI组304例。测定所有患者术前及术后6、12、24、48、72 h共6个时间点的血清和尿液Sema 3A水平以及血清β₂-微球蛋白（β₂-MG）、胱抑素C（Cys C）、血清肌酐（SCr）水平。采用受试者工作特征（ROC）曲线评估各项目诊断CIAKI的性能。采用Spearman相关分析评估不同时间点的尿液Sema 3A水平与临床表现（SCr百分比变化、手术后住院时间和AKI持续时间）的相关性。采用Logistic回归分析评估急性肾损伤（AKI）的预测因子。结果与术前基础值比较,术后24、48、72 h CIAKI组SCr、β₂-MG、Cys C均不同程度升高（P<0.05）,且与非CIAKI组比较差异均有统计学意义（P<0.05）。 Cys C术后48 h的诊断性能最佳。CIAKI组血清Sema 3A水平在术后12、24和48 h升高,而尿液Sema 3A水平在术后6 h即明显增高,升高时间远早于β₂-MG、Cys C、SCr。相关分析显示,术前尿液Sema 3A水平与年龄、术后SCr变化和AKI持续时间呈负相关（P<0.05）,术后6和12 h的高尿液Sema 3A水平与SCr升高及住院时间、AKI持续时间延长明显相关（P<0.01）。Logistic回归分析显示性别、术后6 h 尿Sema 3A水平是独立预测CIAKI的指标。ROC曲线分析显示,术后6 h尿液Sema 3A 诊断CIAKI的性能最佳,最佳临界值为245 pg/μmol Cr,敏感性为84%,特异性为92%,阳性预测值为91%,阴性预测值为87%。结论 Sema 3A与早期肾损伤的发生密切相关,可作为CIAKI的早期生物标志物。

关键词: Semaphorin 3A, 冠状动脉造影术, 对比剂急性肾损伤

Abstract:

Objective To investigate the role of Semaphorin（Sema） 3A in the early diagnosis of contrast-induced acute kidney injury（CIAKI）. Methods A total of 350 patients undergoing coronary angiography and stent implantation were enrolled and classified into 2 groups,CIAKI group（46 cases） and non-CIAKI group（304 cases）. Serum and urinary Sema 3A and serum beta₂-microglobulin（β₂-MG）,cystatin C（Cys C） and serum creatinine（SCr）were determined before surgery and at 6,12,24,48 and 72 h after surgery. Receiver operating characteristic（ROC） curve was performed to evaluate the roles of these parameters for the diagnosis of CIAKI. Spearman correlation analysis was used to identify the relationship between the levels of urinary Sema 3A in different times and clinical manifestation [the percentage changes of SCr,hospitalization time after surgery and the duration of acute kidney injury（AKI）]. Logistic regression analysis was utilized to assess the predictive factors of AKI. Results Compared with preoperative baseline values,SCr,β₂-MG and Cys C in CIAKI group increased to different degrees at 24,48 and 72 h after surgery（P<0.05）,and there was statistical significance compared with those in non-CIAKI group（P<0.05）. Cys C had the best diagnostic performance at 48 h after surgery. The levels of serum Sema 3A in CIAKI group increased at 12,24 and 48 h after surgery,and urinary Sema 3A increased at 6 h after surgery. Compared with β₂-MG,Cys C and SCr,urinary Sema 3A in CIAKI group was increased earlier. Correlation analysis showed that the level of urinary Sema 3A before surgery was negatively correlated with age,the change of SCr after surgery and the duration of AKI（P<0.05）. The high levels of urinary Sema 3A at 6 and 12 h after surgery were correlated with the increasing of SCr,hospitalization time and the duration of AKI（P<0.01）. Logistic regression analysis showed that sex and the level of urinary Sema 3A at 6 h after surgery were independent predictive factors of CIAKI. ROC curve analysis showed that urinary Sema 3A at 6 h after surgery had optimal diagnostic performance in the diagnosis of CIAKI,and the optimal cut-off value was 245 pg/μmol Cr. The sensitivity,specificity,positive predictive value and negative predictive value was 84%,92%,91% and 87%,respectively. Conclusions Sema 3A is closely associated with the occurrence of early kidney injury,which is an early biomarker of CIAKI.

Key words: Semaphorin 3A, Coronary angiography, Contrast-induced acute kidney injury

中图分类号:

R446.1

张艺欣, 宁莉, 魏殿军. Semaphorin 3A早期诊断对比剂急性肾损伤的价值[J]. 检验医学, 2018, 33(11): 997-1003.

ZHANG Yixin, WEI Dianjun, NING Li. Role of Semaphorin 3A in the early diagnosis of contrast-induced acute kidney injury[J]. Laboratory Medicine, 2018, 33(11): 997-1003.

图/表 11

参考文献 11

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组别	例数	性别		年龄（岁）	BMI（kg/m²）	SCr（μmol/L）
组别	例数	男[例（%）]	女[例（%）]	年龄（岁）	BMI（kg/m²）	SCr（μmol/L）
CIAKI组	46	27（58.7）	19（41.3）	67.1±7.9	23.2±4.1	65.0±9.8
非CIAKI组	304	157（51.6）	147（48.4）	60.5±8.5	24.2±3.2	61.6±10.2
P值		<0.05	<0.05	>0.05	>0.05	>0.05
组别	Hb（g/L）	eGFR [mL/（min·1.73 m²）]	HbA_1c（%）	LVEF（%）	BNP（pg/mL）
CIAKI组	118±19	68.1±10.5	7.9±1.3	58±10	256±57
非CIAKI组	129±25	65.1±10.1	7.1±1.1	51±14	201±43
P值	>0.05	>0.05	>0.05	>0.05	>0.05
组别	FPG（mmol/L）	高血压	糖尿病	住院时间（d）	透析	死亡
组别	FPG（mmol/L）	[例（%）]	[例（%）]	住院时间（d）	[例（%）]	[例（%）]
CIAKI组	6.02±1.1	14（50.0）	9（32.1）	11.8±10.6	4（8.7）	1（2.2）
非CIAKI组	5.02±2.5	62（41.9）	75（50.7）	4.8±2.9	0（0.0）	0（0.0）
P值	>0.05	>0.05	<0.05	<0.01	>0.05	>0.05

组别	例数	性别		年龄（岁）	BMI（kg/m²）	SCr（μmol/L）
组别	例数	男[例（%）]	女[例（%）]	年龄（岁）	BMI（kg/m²）	SCr（μmol/L）
CIAKI组	46	27（58.7）	19（41.3）	67.1±7.9	23.2±4.1	65.0±9.8
非CIAKI组	304	157（51.6）	147（48.4）	60.5±8.5	24.2±3.2	61.6±10.2
P值		<0.05	<0.05	>0.05	>0.05	>0.05
组别	Hb（g/L）	eGFR [mL/（min·1.73 m²）]	HbA_1c（%）	LVEF（%）	BNP（pg/mL）
CIAKI组	118±19	68.1±10.5	7.9±1.3	58±10	256±57
非CIAKI组	129±25	65.1±10.1	7.1±1.1	51±14	201±43
P值	>0.05	>0.05	>0.05	>0.05	>0.05
组别	FPG（mmol/L）	高血压	糖尿病	住院时间（d）	透析	死亡
组别	FPG（mmol/L）	[例（%）]	[例（%）]	住院时间（d）	[例（%）]	[例（%）]
CIAKI组	6.02±1.1	14（50.0）	9（32.1）	11.8±10.6	4（8.7）	1（2.2）
非CIAKI组	5.02±2.5	62（41.9）	75（50.7）	4.8±2.9	0（0.0）	0（0.0）
P值	>0.05	>0.05	<0.05	<0.01	>0.05	>0.05

组别	例数	术前基础值	术后
组别	例数	术前基础值	6 h	12 h	24 h	48 h	72 h
CIAKI组	46	53.11±10.30	56.88±12.45	58.71±11.63	68.11±13.24^*#	72.53±12.10^*#	67.11±11.04^*#
非CIAKI组	304	57.22±11.90	54.62±10.01	56.35±12.11	54.16±10.58	55.54±12.42	50.90±11.21

组别	例数	术前基础值	术后
组别	例数	术前基础值	6 h	12 h	24 h	48 h	72 h
CIAKI组	46	53.11±10.30	56.88±12.45	58.71±11.63	68.11±13.24^*#	72.53±12.10^*#	67.11±11.04^*#
非CIAKI组	304	57.22±11.90	54.62±10.01	56.35±12.11	54.16±10.58	55.54±12.42	50.90±11.21

组别	例数	术前基础值	术后
组别	例数	术前基础值	6 h	12 h	24 h	48 h	72 h
CIAKI组	46	1.59±0.71	1.52±0.68	1.62±0.87	1.82±0.74^*#	2.13±0.50^*#△▲	1.55±0.62
非CIAKI组	304	1.54±0.74	1.51±0.63	1.55±0.44	1.49±0.74	1.49±0.85	1.50±0.76