nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2019-236-61-72nefr-1770Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОценка эффективности использования биомаркеров в предиктивной и ранней диагностике острого повреждения почек при остром коронарном синдроме (пилотное исследование)Evaluation of biomarkers effi ciency in predictive and early diagnostics of acute kidney damage in acute coronary syndrome (pilot study)https://orcid.org/0000-0003-4528-9373ВоробьевЕ. А.VorobyevE. A.

Воробьев Евгений Александрович, врач-нефролог

197022, Санкт-Петербург, ул. Л. Толстого, д. 17, корп. 54

Eugene A. Vorobyev, MD, nephrologist

197022, St. Petersburg, L. Tolstoy st., 17, build 54

vorobyeveval@gmail.comhttps://orcid.org/0000-0001-7265-7392ГалкинаО. В.GalkinaO. V.

Галкина Ольга Владимировна, кандидат биологических наук, заведующая лабораторией биохимического гомеостаза

197022, Санкт-Петербург, ул. Л. Толстого, д. 17

Olga V. Galkina, PhD in Biology, Head of The Laboratory of Biochemical Homeostasis

197022, St. Petersburg, L. Tolstoy st., 17, build 54

ovgalkina@mail.ruЗубинаИ. М.ZubinaI. M.

Зубина Ирина Михайловна, кандидат биологических наук, лаборатория биохимического гомеостаза

197022, Санкт-Петербург, ул. Л. Толстого, д. 17

Irina M. Zubina, PhD in Biology, Laboratory of Biochemical Homeostasis

197022, St. Petersburg, L. Tolstoy st., 17, build 54

zubina@list.ruАнпиловаА. О.AnpilovaA. O.

Анпилова Анастасия Олеговна, лаборатория биохимического гомеостаза

197022, Санкт-Петербург, ул. Л. Толстого, д. 17

Anastasia O. Anpilova, Laboratory of Biochemical Homeostasis

197022, St. Petersburg, L. Tolstoy st., 17, build 54

anastasy.95@mail.ruhttps://orcid.org/0000-0003-1969-1959БогдановаЕ. О.BogdanovaE. O.

Богданова Евдокия Олеговна, кандидат биологических наук, лаборатория биохимического гомеостаза

197022, Санкт-Петербург, ул. Л. Толстого, д. 17

Evdokia O. Bogdanova, PhD in Biology, Laboratory of Biochemical Homeostasis

197022, St. Petersburg, L. Tolstoy st., 17, build 54

evdokia.bogdanova@gmail.comЛевыкинаЕ. Н.LevykinaE. N.

Левыкина Елена Николаевна, кандидат химических наук, лаборатория биохимического гомеостаза

197022, Санкт-Петербург, ул. Л. Толстого, д. 17

Elena N. Levykina, PhD in Chemistry, Laboratory of Biochemical Homeostasis

197022, St. Petersburg, L. Tolstoy st., 17, build 54

levykinalena@mail.ruКучерА. Г.KucherA. G.

Кучер Анатолий Григорьевич, профессор, заместитель директора

197022, Санкт-Петербург, ул. Л.Толстого, д. 17, корп. 54

Anatoly G. Kucher, MD, PhD, DMedSci., Research and Сlinical Research Center, Vice-Director

197022, St. Petersburg, L. Tolstoy st., 17, build 54

prof.kucher@yandex.ruНаучно-исследовательский институт нефрологии Первого Санкт-Петербургского государственного медицинского университета им. акад. И.П. ПавловаРоссияResearch Institute of Nephrology, Pavlov First Saint-Petersburg State Medical UniversityRussian Federation2019251220192366172Copyright © Воробьев Е.А., Галкина О.В., Зубина И.М., Анпилова А.О., Богданова Е.О., Левыкина Е.Н., Кучер А.Г., 20192019Воробьев Е.А., Галкина О.В., Зубина И.М., Анпилова А.О., Богданова Е.О., Левыкина Е.Н., Кучер А.Г.Vorobyev E.A., Galkina O.V., Zubina I.M., Anpilova A.O., Bogdanova E.O., Levykina E.N., Kucher A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1770ВВЕДЕНИЕ

ВВЕДЕНИЕ. Острое повреждение почек (ОПП) – распространенное осложнение острого коронарного синдрома (ОКС), ассоциированное с высокой смертностью и неблагоприятным прогнозом. Профилактика и раннее вмешательство являются наиболее эффективной стратегией в случае ОПП любой этиологии.

ЦЕЛЬ

ЦЕЛЬ: изучение возможности использования клинических факторов и биомаркеров в предиктивной и ранней диагностике ОПП при ОКС.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. В проспективное когортное исследование включали пациентов, госпитализированных с диагнозом ОКС в ПСПбГМУ им. И.П. Павлова. При исключении ОКС пациентов определяли в группу сравнения, при подтверждении диагноза ОКС – в группу исследования. Забор биоматериала (кровь и моча) проводили при поступлении (Т1), через 1 сут (Т2) и через 2 сут после поступления (Т3). Для диагностики ОПП использовали критерии ОПП KDIGO 2012 года. Определяли концентрации NGAL, KIM-1, цистатина С, sST2, тропонина I.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. В исследование включены 73 человека, диагноз ОКС подтвержден у 40 человек, развитие ОПП – у 15 (все из группы ОКС). Наиболее значимой для предиктивной диагностики развития ОПП любой стадии были: ЧСС>89 в 1 мин (AUC=0,798, p=0,001) и риск по шкале GRACE>133 баллов (AUC=0,926, p=0,005). Среди исследованных биомаркеров, по данным ROC-анализа, для предиктивной диагностики ОПП значение имели NGAL и ST2 в моче: при уровне NGAL>32 нг/мл (AUC=0,814, p=0,04), sST2>23,4 нг/мл (AUC=0,718, p=0,02).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. При исследовании биомаркеров наиболее перспективным представляется использование sST2 и NGAL в моче, которые вместе с параметрами гемодинамики, обладают высокой предсказательной способностью в диагностике ОПП при ОКС.

INTRODUCTION

INTRODUCTION. Acute Kidney Injury (AKI) is a common complication of acute coronary syndromes (ACS), and associated with higher mortality and adverse outcomes. Despite advances in research over the past years, effective treatments for current AKI are not available. Prevention and early intervention remain the most effective strategies for AKI of any entity. THE AIM: This study aimed to explore a risk factors and biomarkers for predictive and early diagnostic of AKI in ACS.

PATIENTS AND METHODS

PATIENTS AND METHODS. Study was prospective and cohort, patients hospitalized with ACS in Pavlov First Saint Petersburg State Medical University were included. In case of exclusion of ACS, patients were determined in the comparison group, in case of confirmation of the diagnosis of ACS – in the study group. Biomaterial (blood and urine) was taken at admission (T1), 1 day after admission (T2) and 2 days after admission (T3). For the diagnosis of AKI, KDIGO 2012 criteria were used. The measured biomarkers at each point were NGAL, KIM-1, cystatin C, sST2, troponin I. RESULTS. The study included 73 patients, the diagnosis of ACS was confirmed in 40 patients and AKI development was in 15 patients, all from the ACS group. The most significant for predictive diagnosis was the assessment of the parameters of systemic hemodynamics and the severity of acute heart failure (AHF): heart rate>89 (AUC=0,798, p=0,001), GRACE Risk Score>133 (AUC=0,926, p=0,005). In evaluation the suitability of biomarkers in terms of prognostic diagnosis of AKI, urine NGAL>32 ng/ml (AUC=0,814 p=0,04) and sST2>23.4 ng/ml (AUC=0,718, p=0,02) showed the best results.

CONCLUSIONS

CONCLUSIONS. In study of biomarkers efficiency, the use of urine sST2 and NGAL is most promising. Together with hemodynamic parameters, biomarkers have high predictive ability in the diagnosis of AKI in ACS.

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The authors declare that there are no conflicts of interest present.