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