血清klotho蛋白对心脏瓣膜置换术后急性肾损伤监测的研究

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1、硕士学位论文UsefulnessofserumKlothoinearlydetectionofacutekidneyinjuryaftercardiacvalvereplacementsurgeryName：Sun—huadongSupervisor：Prof．Zou-xiaomingABSTRACT[Background]：Acutekidneyinjury(AKI)isacommonandseverecomplicationaftercardiacsurgeryandisanindependentri

2、skfactorforaseriesofadverseoutcomes，includingprolongedintensivecareandhospitalstays，andincreasedlong．termmortalityrate．Theincidenceofcardiopulmonarybypassassociatedacutekidneyinjury(CPB—AKI)isreportedabout5％-47％．ThepossiblemechanismsofCPB—AKIarefollowedas

3、below：Thelowflowandpulselessperfusionduringthecardiopulmonarybypass，activationofproinflammatorymediatorsduringthecontactbetweenbloodandsurfaceofCPBtube，thereleaseoffreehemoglobinandmyohemoglobinduringCPBcausedbythehemolysisandinjuryofmusclecanalsoleadtoth

4、edamageofrenaltubular，besidesthehemodilution，generationofmicroemboli，kidneytoxicantmayalsoplayasubtleroleinCPB—AKI．TheserumcreatinineandurinaryvolumeareusedmostcommonlyinthedetectionofCPB—AKIrecently,however,thelevelofserumcreatininecanbesusceptibletogend

5、er,age，weight，musclemassandSOon，besides，itisbelievedassociatedonlywiththeGFRwhichcannotreflecttheinjuryofrenaltubular，finally，undertheunstablestateduringtheCPB，itisreportedthatserumcreatininecannotbeanexcellentrefectofGFR．Urinaryoutputiseasilyinfluencedby

6、volumeloadandtheuseofABSTRACTdiureticum．Therefore，itisinfluentialtoporbethesensitiveandspecificbiomarkerswhichcouldbeusedinearlydetectionofCPB—AKI．CystatinCisakindofnon—glycosylatedproteinwhichcanbesynthetisedbykaryocytesandreleasedintothebloodataconstant

7、speed．CystatinCcallbefilteredfromrenalglomerulusandreabsorbtedbytheproximaltubulescompletely．Particularly,theamountofCystatinCcanhardlybeaffectedbytheage，weight，musclemassandSOon，whichtheoreticallybecomeallidealbiomarkerforthefiltrationfunction．Whereas，ti

8、lnow,itiSstilladebatableissuewhenitcomestoapreferentialchoicebetweenSCrandCystatinCfordetectionofCPB—AKI．Withthedevelopmentofgenomicandproteomics，toprobesomenewbiomarkerswhichareusedtodetectAKIhasbecomethehotspotint