Page 75 - 南京医科大学学报自然科学版

第41卷第4期 南京医科大学学报（自然科学版）
2021年4月 Journal of Nanjing Medical University（Natural Sciences） ·545 ·

·临床医学·

尿ATF3、Kim⁃1以及联合检测在体外循环心脏术后急性肾损伤

中的诊断价值

吴晓云 ，金相兰 ，周 健 ，臧旺福 1*
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南京医科大学附属上海十院临床医学院，上海 200072；同济大学附属上海市第十人民医院心脏外科，上海 200072
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［摘 要］ 目的：探讨尿转录活化因子 3（activating transcription factor 3，ATF3）和肾损伤因子 1（kidney injury molecule 1，Kim⁃
1）对体外循环（cardiopulmonary bypass，CPB）心脏手术后急性肾损伤（acute kidney injury，AKI）早期诊断的价值。方法：选取
2018年1月—2019年12月于上海市第十人民医院心脏外科行体外循环心脏手术的患者83例，根据改善全球肾脏疾病预后组
织诊断标准分为AKI组和非AKI组。收集患者术前及术后2 h、6 h、12 h、24 h、48 h尿液样本，采用酶联免疫吸附试验检测各时
间点尿ATF3和Kim⁃1的水平，并计算尿［ATF3］·［Kim⁃1］的值。通过绘制受试者工作特征（ROC）曲线计算曲线下面积（AUC），
评估尿ATF3、Kim⁃1以及［ATF3］·［Kim⁃1］早期诊断AKI的临床价值。结果：共42例患者发生AKI。与非AKI组相比，AKI组患者
术后6 h、12 h尿ATF3明显升高，且术后12 h尿ATF3水平诊断AKI的AUC为0.691（95%CI：0.576~0.807，截断值为1 216 pg/mL
时，灵敏度为0.43，特异度为0.85。尿［ATF3］·［Kim⁃1］联合检测的AUC在术后6 h为0.712，达到最高值，灵敏度和特异度分别
为0.57和0.78。结论：尿ATF3在体外循环心脏术后患者的尿液中早期表达，可以作为成人体外循环术后AKI的诊断标志物。
联合使用的预测价值高于单个检测，是增加诊断准确度的可行办法。
［关键词］ 急性肾损伤；早期诊断；体外循环；ATF3；Kim⁃1
［中图分类号］ R654.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）04⁃545⁃06
doi：10.7655/NYDXBNS20210412

Diagnostic value of urinary ATF3，Kim⁃1 and their combination in acute renal injury after
cardiopulmonary bypass heart surgery

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WU Xiaoyun ，JIN Xianglan ，ZHOU Jian ，ZANG Wangfu 1*
Shanghai 10th Clinical Medical College，Nanjing Medical University，Shanghai 200072； Department of
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Cardiacsurgery，Shanghai 10th People’s Hospital，Tongji University，Shanghai 200072，China
［Abstract］ Objective： To investigate the value of urinary activating transcription factor 3（ATF3）and kidney injury molecule 1（Kim⁃
1）in the early diagnosis of acute kidney injury（AKI）after cardiopulmonary bypass（CPB）heart surgery. Methods：A total of 83
patients who underwent elective CPB surgery in the Department of Cardiac Surgery of Shanghai 10th People’s Hospital from January
2018 to December 2019 were selected and divided into AKI group and non⁃AKI group according to KIDGO diagnostic criteria. Urine
samples were collected preoperatively and 2 h，6 h，12 h，24 h，and 48 h after surgery，the levels of ATF3 and Kim⁃1 in urine were
determined by enzyme⁃linked immunosorbent assay（ELISA），and［ATF3］·［Kim⁃1］was calculated. The area under the curve（AUC）
was obtained by drawing the receiver operating curve（ROC）to evaluate the clinical value of urinary ATF3，Kim⁃1，and［ATF3］·［Kim⁃
1］for early diagnosis of AKI. Results：A total of 42 patients developed AKI. Compared with the non⁃AKI group，urinary ATF3 was
significantly increased at 6 h and 12 h postoperatively，and the AUC for the diagnosis of AKI at 12 h postoperatively was 0.691（95%CI：
0.576~0.807，the sensitivity and specificity were 0.43 and 0.85 when the cutoff value was 1 216 pg/mL）. The AUC of［ATF3］·［Kim⁃1］
combined detection was 0.712 at 6 h after surgery，reaching the highest value，and the sensitivity and specificity were 0.57 and 0.78，
respectively. Conclusion：Urinary ATF3 is expressed early in the urine of patients after CPB，and can be used as a diagnostic marker
for AKI after CPB in adults. The predictive value of combined use is higher than that of single test，and it is a feasible way to increase

［基金项目］ 上海市卫生和计划生育委员会科研课题（201740243）
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通信作者（Corresponding author），E⁃mail：zangwf@hotmail.com