急性肾损伤（acute kidney injury, AKI）是外科非心脏手术患者术后常见并发症，围手术期多种因素可导致其发生，与患者不良近远期预后密切相关。早期发现肾急性损伤是当前研究的热点，血/尿生物标志物的出现为AKI早期诊断和预后判断带来了希望。然而，目前多数研究集中于心脏手术和ICU患者。文章结合当前文献，对血/尿生物标志物在外科非心脏手术患者AKI中的早期诊断及预后判断价值进行综述，回顾当前在非心脏手术研究中热点生物标志物［包括中性粒细胞明胶酶相关载脂蛋白（neutrophil gelatinase‑associated lipocalin, NGAL）、肝型脂肪酸结合蛋白（liver type fatty acid‑binding protein, L‑FABP）、金属蛋白酶组织抑制剂2 （tissue inhibitor of metalloproteinase‑2, TIMP‑2）和胰岛素样生长因子结合蛋白7（insulin like growth factor binding protein 7, IGFBP‑7）］对其病理生理学作用、代谢机制、在诊断及预后判断中的作用及测量影响因素进行阐述，总结生物标志物导向的干预性治疗。新型生物标志物将对非心脏手术患者围手术期AKI的诊断和治疗发挥更大作用。
Acute kidney injury (AKI) is a common complication after non‑cardiac surgery with a variety of risk factors during perioperative period, resulting in adverse short and long‑term outcomes of patients. Nowadays, early detection of injury in kidney is the first priori, development of novel biomarker making this possible. However, research in this field are mainly focused on cardiac surgery and ICU patients. In this article, it was reviewed the available literature on characteristics of promising AKI biomarkers that are currently the focus of preclinical and clinical investigations in non‑cardiac surgery patients. These biomarkers include neutrophil gelatinase‑associated lipocalin (NGAL), liver‑type fatty acid‑binding protein (L‑FABP), insulin‑like growth factor‑binding protein 7（IGFBP‑7） and tissue inhibitor of metalloproteinase 2 (TIMP‑2). It was then described the clinical performance of these biomarkers for diagnosis and prognostication of AKI. Finally, the study on biomarker guided interventional therapy for patients at high risk of postoperative AKI was reviewed. Novel biomarker will play a more important role in the diagnosis and treatment for AKI in patients after non‑cardiac surgery.
Cited
)
