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

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摘要目的探讨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3 h、24 h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3 h[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3 h、24 h[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。

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关键词 ： 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

Abstract：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 infants and young children after cardiopulmonary bypass (CPB) cardiac surgery. Methods A total of 50 children who underwent cardiac 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 Nephrology (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 receiver operating characteristic curve (ROC). Results Compared with the non-AKI group,the preoperative DKK3 levels and the levels 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 after 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.

Key words： DKK3 TIMP-2 IGFBP7 acute kidney injury cardiopulmonary bypass infants and young children

收稿日期: 2024-12-23

ZTFLH:

R726.9

基金资助:首都卫生发展科研专项项目（2020-2-5092）

通讯作者: 刘永哲,E-mail： lyzgao@163.com

作者简介: 范春玲,硕士研究生,主治医师。

引用本文:

范春玲, 郭文治, 刘永哲. 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[J]. 武警医学, 2025, 36(5): 388-393. FAN Chunling, GUO Wenzhi, LIU Yongzhe. Predictive value of three detection indicators for acute kidney injury after cardiac surgery in infants and young children. Med. J. Chin. Peop. Armed Poli. Forc., 2025, 36(5): 388-393.

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https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2025/V36/I5/388

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