动态监测血清脑钠肽、尿肾损伤分子-1、血清胱抑素C水平对小儿心脏术后急性肾损伤的评估价值

doi:10.3969/j.issn.1006-5725.2025.13.004

摘要/Abstract

摘要：

目的分析动态监测血清脑钠肽（BNP）、尿肾损伤分子-1（KIM-1）、血清胱抑素C（CysC）水平变化对小儿心脏术后急性肾损伤（AKI）的评估价值。方法选择2023年1月至2024年6月接受体外循环先天性心脏病纠治术的患儿138例，统计患儿术后AKI发生率，并据此分为AKI组和非AKI组。动态监测两组患儿血清BNP、KIM-1、CysC变化水平，并进行比较，采用受试者特征曲线（ROC）对小儿心脏术后AKI发生及病情严重程度进行评估。结果 138例患儿中，有57例（41.30%）发生AKI。AKI组中，分为轻度组（n = 20）和中重度组（n = 37）；关于AKI组和非AKI组：术后6、12、24、48 h不同时间BNP、KIM-1、CysC水平差异有统计学意义（P < 0.05），AKI组BNP、KIM-1、CysC水平比非AKI组较高（P < 0.05），两组BNP、KIM-1、CysC水平变化趋势差异有统计学意义（P < 0.05）；多因素logistic回归分析结果显示，BNP、KIM-1、CysC均是小儿心脏术后发生AKI的影响因素（P < 0.05）；ROC曲线显示，三项联合预测小儿心脏术后AKI发生的AUC为0.893，明显高于BNP、KIM-1、CysC的0.723、0.812、0.761；关于轻度组和中重度组，术后 6、12、24、48 h不同时间BNP、KIM-1、CysC水平差异有统计学意义（P < 0.05），轻度组BNP、KIM-1、CysC水平比中重度组较低（P < 0.05），两组BNP、KIM-1、CysC水平变化趋势差异有统计学意义（P < 0.05）；多因素logistic回归分析结果显示，BNP、KIM-1、CysC均是影响小儿心脏术后AKI病情严重程度的因素（P < 0.05）；ROC曲线显示，三项联合评估AKI病情严重程度的AUC为0.908，明显高于BNP、KIM-1、CysC的0.780、0.762、0.720。结论动态监测血清BNP、KIM-1、CysC水平变化对小儿心脏术后AKI的发生及病情严重程度均具有较高的评估价值，且联合检测的评估价值更高。

关键词: 脑钠肽, 尿肾损伤分子-1, 血清胱抑素C, 先天性心脏病, 急性肾损伤

Abstract:

Objective To analyze the evaluation value of dynamic monitoring of changes in serum brain natriuretic peptide （BNP）， urinary kidney injury molecule-1 （KIM-1）， and serum cystatin C （CysC） levels in acute kidney injury （AKI） after pediatric heart surgery. Methods 138 children who underwent cardiopulmonary bypass for congenital heart disease correction in our hospital from January 2023 to June 2024 were selected. The incidence of postoperative AKI in children was counted and they were divided into the AKI group and the non-AKI group accordingly. The changing levels of serum BNP， KIM-1， and CysC in the two groups of children were dynamically monitored and compared. The receiver operating characteristic curve （ROC） was used to evaluate the occurrence and severity of AKI after pediatric heart surgery. Results Among the 138 children， 81 did not develop AKI and 57 developed AKI， with an incidence rate of 41.30%. In the AKI group， there were a mild group （n = 20） and a moderate-severe group （n = 37）. Regarding the AKI group and the non-AKI group： there were differences in the levels of BNP， KIM-1， and CysC at 6 h， 12 h， 24 h， and 48 h after surgery （P < 0.05）. The levels of BNP， KIM-1， and CysC in the AKI group were higher than those in the non-AKI group （P < 0.05）， and there were differences in the changing trends of BNP， KIM-1， and CysC levels between the two groups （P < 0.05）. The results of multivariate Logistic regression analysis showed that BNP， KIM-1 and CysC were all factors influencing the occurrence of AKI after pediatric cardiac surgery （P < 0.05）. The ROC curve showed that the AUC of the three combined to predict the occurrence of AKI after pediatric heart surgery was 0.893， which was significantly higher than 0.723， 0.812， and 0.761 of BNP， KIM-1， and CysC respectively. Regarding the mild group and the moderate-severe group： there were differences in the levels of BNP， KIM-1， and CysC at 6 h， 12 h， 24 h， and 48 h after surgery （P < 0.05）. The levels of BNP， KIM-1， and CysC in the mild group were lower than those in the moderate-severe group （P < 0.05）， and there were differences in the changing trends of BNP， KIM-1， and CysC levels between the two groups （P < 0.05）. The results of multivariate Logistic regression analysis indicated that BNP， KIM-1 and CysC were all factors influencing the severity of AKI after pediatric cardiac surgery （P < 0.05）. The ROC curve showed that the AUC of the three combined to evaluate the severity of AKI was 0.908， which was significantly higher than 0.780， 0.762， and 0.720 of BNP， KIM-1， and CysC respectively. Conclusion Dynamic monitoring of changes in serum BNP， KIM-1， and CysC levels has a high evaluation value for the occurrence and severity of AKI after pediatric heart surgery， and the combined detection has a higher evaluation value.

Key words: brain natriuretic peptide, urinary kidney injury molecule-1, serum cystatin c, congenital heart disease, acute kidney injury

中图分类号:

R726

吴澄,金泓毅,钟小梅. 动态监测血清脑钠肽、尿肾损伤分子-1、血清胱抑素C水平对小儿心脏术后急性肾损伤的评估价值[J]. 实用医学杂志, 2025, 41(13): 1964-1970.

Cheng WU,Hongyi JIN,Xiaomei ZHONG. Dynamic monitoring of serum brain natriuretic peptide， urinary kidney injury molecule 1 and serum cystatin C levels in the evaluation of acute kidney injury in children after cardiac surgery[J]. The Journal of Practical Medicine, 2025, 41(13): 1964-1970.

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参考文献 25

[1]	YOUNG A M， STROBEL R J， ROTAR E P， et al. Perioperative acetaminophen is associated with reduced acute kidney injury after cardiac surgery［J］. J Thorac Cardiov Sur， 2024， 167（4）： 1372-1380. doi:10.1016/j.jtcvs.2022.09.005 doi: 10.1016/j.jtcvs.2022.09.005
[2]	GUPTA S， GAUR B K， JAIN R， et al. Incidence， risk factors， and outcomes of acute kidney injury in preterm neonates hospitalized in the neonatology unit， North India： a single-center experience［J］. Saudi J Kidney Dis Transpl， 2023， 34（6）： 592-601.
[3]	章燕，陈昊涵，周彦楠，等. 基于文献计量学分析小儿心脏术后急性肾损伤研究热点［J］. 中国体外循环杂志， 2024， 22（4）： 298-304.
[4]	JOFFE R， AKLABI M AL， BHATTACHARYA S， et al. Cardiac surgery-associated kidney injury in children and renal oximetry［J］. Pediatr Crit Care Med， 2018， 19（9）： 839-845. doi:10.1097/pcc.0000000000001656 doi: 10.1097/pcc.0000000000001656
[5]	LYSAK N， BIHORAC A， HOBSON C. Mortality and cost of acute and chronic kidney disease after cardiac surgery［J］. Curr Opin Anaesthesiol， 2017， 30（1）： 113-117. doi:10.1097/aco.0000000000000422 doi: 10.1097/aco.0000000000000422
[6]	高星辰，陶月红，郭玉秀. 血清胱抑素C联合视黄醇结合蛋白在儿童1型糖尿病酮症酸中毒急性肾损伤中的预测价值［J］. 中国妇幼保健， 2023， 38（12）： 2199-2202.
[7]	王斌，胡丹，王芳芳. 血清尿酸及脑钠肽水平与射血分数保留心衰房颤患者房颤结构重构关系［J］. 实用医学杂志， 2023， 39（20）：2633-2637. doi:10.3969/j.issn.1006-5725.2023.20.014 doi: 10.3969/j.issn.1006-5725.2023.20.014
[8]	BRILLAND B， BOUND'HORS C， WACRENIER S， et al. Kidney injury molecule 1 （KIM-1）： a potential biomarker of acute kidney injury and tubulointerstitial injury in patients with ANCA-glomerulonephritis［J］. Clin Kidney J， 2023， 16（9）： 1521-1533. doi:10.1093/ckj/sfad071 doi: 10.1093/ckj/sfad071
[9]	李晓玲，周文杰，邓伟，等. 凝血指标联合血清胱抑素C对脓毒症急性肾损伤患者预后的预测价值［J］. 实用医学杂志， 2023， 39（1）： 81-85.
[10]	梁峰，沈珠军，方全，等. 2015年欧洲心脏病学会关于心肌病，遗传性心律失常，小儿和先天性心脏病患者室性心律失常治疗和心脏性猝死预防指南解读［J］. 中国心血管杂志， 2016， 21（5）： 413-418.
[11]	Disease Kidney ： Improving Global Outcomes （KDIGO） Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury［J］. Kidney Int Suppl， 2012， 2（1）： 1-138.
[12]	KOVACS A H， LUYCKX K， THOMET C， et al. Anxiety and Depression in Adults With Congenital Heart Disease［J］. J Am Coll Cardiol， 2024， 83（3）： 430-441. doi:10.1016/j.jacc.2023.10.043 doi: 10.1016/j.jacc.2023.10.043
[13]	TRAN M， MINER A， MERKEL C， et al. Sociodemographic profile associated with congenital heart disease among infants <1 year old［J］. J Pediatr Nurs， 2023， 73： e618-e623. doi:10.1016/j.pedn.2023.11.007 doi: 10.1016/j.pedn.2023.11.007
[14]	LIN W H， ZHOU S J， CHEN X H， et al. Changes of serum TSH， FT3， and FT4 levels in infants received surgical correction of congenital heart disease under cardiopulmonary bypass［J］. BMC Cardiovasc Disor， 2023， 23（1）： 562. doi:10.1186/s12872-023-03590-4 doi: 10.1186/s12872-023-03590-4
[15]	SHU A H， WANG Q， CHEN X B， et al. Study on the cerebral protective effects of dexmedetomidine during anesthesia for surgical correction of congenital heart disease with cardiopulmonary bypass［J］. Int J Clin Exp Med， 2017， 10（12）： 16562-16568.
[16]	BALAKNIN D， CHERMNYKH I， IVKIN A， et al. Cardiac Surgery-Associated Acute Kidney Injury in Children after Cardiopulmonary Bypass［J］. Kidney Dialysis， 2024， 4（2）： 116-125. doi:10.3390/kidneydial4020009 doi: 10.3390/kidneydial4020009
[17]	戴颖，程瑞朵，汪奇伟. 血清miR-494对重症肺炎并发急性肾损伤儿童死亡的预测效果［J］. 河南大学学报（医学版）， 2021， 40（4）： 246-250， 254.
[18]	郑因碧，邵义明，黎焯基，等. 右美托咪定对脓毒症急性肾损伤患者的肾功能影响的队列研究［J］. 实用医学杂志， 2024， 40（10）： 1423-1428.
[19]	龚英伟，任凯媚，赵璐. 超声心动图联合孕妇血清脑钠肽和同型半胱氨酸检测对胎儿先天性心脏病的诊断效能［J］. 心电与循环， 2023， 42（4）： 358-361.
[20]	WANG H， CAO X Y， LI B Q， et al. Incidence and predictors of postoperative acute kidney injury in older adults with hip fractures［J］. Arch Gerontol Getiat， 2023， 112： 105023. doi:10.1016/j.archger.2023.105023 doi: 10.1016/j.archger.2023.105023
[21]	FU Y L， SUN D Q， QIN Y， et al. Development and application of an amplified luminescent proximity homogeneous assay-linked immunosorbent assay for the accurate quantification of kidney injury molecule-1［J］. Front Mol Biosci， 2024， 10： 1280681. doi:10.3389/fmolb.2023.1280681 doi: 10.3389/fmolb.2023.1280681
[22]	PENG P Q， FU X C， WANG Y T， et al. The value of serum cystatin c in predicting acute kidney injury after cardiac surgery： A systematic review and meta-analysis［J］. Plos One， 2024， 19（11）： e0310049. doi:10.1371/journal.pone.0310049 doi: 10.1371/journal.pone.0310049
[23]	SINGH D P， MONDAL S， SARKAR D. Assessment of Plasma Cystatin C as a Marker of Acute Renal Injury in Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Renal Stone Disease［J］. Cureus J Med Science， 2024， 16（8）： e67293.
[24]	胡秀红，牛哲莉，王静，等. 肾损伤分子-1、胱抑素C和尿肌酐联合检测对先心病体外循环术所致急性肾损伤的诊断价值［J］. 海南医学， 2015， 26（13）： 1934-1937.
[25]	薛炎，王立新，周帆，等. 血清BNP、CK-MB、H-FABP水平早期动态检测对先心病合并肺炎患儿病情评估的临床价值［J］. 临床和实验医学杂志， 2020， 19（3）： 282-286.

项目	AKI组（n = 57）	非AKI组（n = 81）	t/χ²值	P值
性别/例			0.180	0.671
男	31	47
女	26	34
年龄/岁	5.12 ± 0.87	4.83 ± 1.00	1.768	0.079
体质量指数/（kg/m²）	16.11 ± 0.54	16.20 ± 0.66	0.849	0.398
心功能分级/［例（%）］			0.921	0.337
Ⅰ级	37	46
Ⅱ级	20	35
手术方式/［例（%）］			3.204	0.073
姑息	4	1
根治	53	80
手术时间/min	200.55 ± 14.64	196.29 ± 15.69	1.614	0.109
体外循环时间/min	118.68 ± 32.14	111.26 ± 27.19	1.463	0.146
术中尿量/［mL/（kg·h）］	6.89 ± 2.86	7.17 ± 2.60	0.598	0.551

项目	轻度组（n = 20）	中重度组（n = 37）	t/χ²值	P值
性别/例			0.391	0.531
男	12	19
女	8	18
年龄/岁	5.20 ± 0.96	5.08 ± 0.80	0.504	0.617
体质量指数/（kg/m²）	16.05 ± 1.45	16.14 ± 1.66	0.204	0.839
心功能分级/［例（%）］			0.350	0.554
Ⅰ级	14	23
Ⅱ级	6	14
手术方式/［例（%）］			0.192	0.661
姑息	1	3
根治	19	34
手术时间/min	195.88 ± 21.29	203.07 ± 17.54	1.369	0.177
体外循环时间/min	121.98 ± 22.87	116.90 ± 20.13	0.867	0.390
术中尿量/［mL/（kg·h）］	7.00 ± 1.36	6.83 ± 1.55	0.412	0.682

组别	时间	BNP/（pg/mL）	KIM-1/（μmol/L）	CysC/（mg/L）
AKI组（n = 57）	6 h	412.64 ± 25.90	460.87 ± 51.25	1.50 ± 0.32
	12 h	464.08 ± 41.13	626.52 ± 60.11	1.86 ± 0.55
	24 h	537.04 ± 51.26	585.67 ± 53.53	2.18 ± 0.63
	48 h	488.08 ± 53.09	578.13 ± 59.93	1.85 ± 0.58
非AKI组（n = 81）	6 h	368.46 ± 28.98	343.89 ± 45.29	0.93 ± 0.28
	12 h	423.76 ± 36.27	398.75 ± 54.14	1.13 ± 0.36
	24 h	512.56 ± 42.59	548.74 ± 62.20	1.53 ± 0.44
	48 h	446.39 ± 38.43	511.97 ± 40.54	1.32 ± 0.42
F组间/P组间		18.655/0.000	16.657/0.000	12.549/0.000
F时间/P时间		22.097/0.000	20.989/0.000	15.632/0.000
F交互/P交互		14.676/0.000	18.534/0.000	11.163/0.000

变量	β	SE	Wald χ²值	P值	OR	95%CI
BNP	0.932	0.403	5.348	0.021	2.540	1.153 ~ 5.595
KIM-1	1.112	0.398	7.806	0.005	3.040	1.394 ~ 6.633
CysC	0.823	0.280	8.639	0.003	2.277	1.315 ~ 3.942

指标	截点值	AUC	敏感度/%	特异度/%	95%CI	P值^*
BNP	469.59 pg/mL	0.723	63.16	80.25	0.641 ~ 0.796	0.000
KIM-1	548.16 μmol/L	0.812	71.93	82.72	0.737 ~ 0.873	0.010
CysC	1.76 mg/L	0.761	63.16	85.19	0.681 ~ 0.830	0.000
三项联合	-	0.893	87.72	79.01	0.830 ~ 0.940	-