The Clinical Significance Of NGAL、HO-1in Valve Replacement Surgery-induced Acute Kidney Injury And Intervention Study

Objective:Take rheumatic valvular heart disease patients with the optional period of line valvular replacement surgery as the research object, inducing remote ischemic conditioning during the cardiac surgery.To investigate the occurrence of acute kidney injury,the renoprotective effect of remote ischemic conditioning after heart valve replacement and the pathological mechanism and precaution of heart-renal syndrome after heart valve replacement surgery.Methods:A study was conducted in46patients admitted for selective valve replacement,and divide them into3groups with random. Control patients (CON. n=16) underwent sham placement of the tourniquet around the left thigh without inflation;the remote ischemic perconditioning group (RPerC. n=15) received3cycles of5/5min ischemia and reperfusion in the left thigh after aortic cross-clamping,the remote ischemic postconditioning group (RpostC.n=15) received3cycles of5/5min ischemia and reperfusion in the left thigh after aortic cross-release,the limb ischemia was induced by the tourniquet inflated to600mmHg. Serum creatinine (scr) and blood urea nitrogen (BUN) were measured preoperatively6h,12h,24h and48h after aortic cross-release,Venous blood and urinary samples were obtained preoperatively6h,12h,24h and48h after aortic cross-release,These samples were centrifuged at2000r/min for10minutes,and the supernatant were stored at-80℃until assay.Serum samples were analyzed by enzyme-linked immunosorbent assay(ELISA) for NGAL level.while serum samples were analyzed by ELISA for HO-1.Serum iron were analyzed by automatic biochemical analyzer.Record CPB time, aortic clump time,and automatic compound jump proportion.Results: l.Campared with the preoperative level,the Ccr、BUN、urinary NGAL、Serum iron(6h,12h) and serum HO-1values were significantly increased after heart valve replacement surgery in control patients group(P<0.05);the Ccr、BUN、urinary NGAL、Serum iron(6h,12h) and serum HO-1values were significantly increased after heart valve replacement surgery in RPerC group(P<0.05); the Ca、BUN、urinary NGAL、Serum iron(6h,12h) and serum HO-1values were significantly increased after heart valve replacement surgery in RPostC group(P<0.05).2. Campared with control group,the serum HO-1was significantly increased12h,24h and48h after heart valve replacement surgery in RPerC group(P<0.05);the serum HO-1was significantly increased24h and48h after heart valve replacement surgery in RPostC group(P<0.05); campared with control group, the Ccr、BUN、urinary NGAL、and Serum iron values were decreased6h,12h,24h and48h after heart valve replacement surgery in RPerC and RPostC group (P>0.05).Conclusion:(1) The risk of AKI is increased in patients with underlying heart conditions after Cardiopulmonary bypass Cardiac surgery.(2) When cardiorenal syndrome occurs among patients under heart valve replacement surgery, urinary NGAL、Serum iron and HO-1abnormal change,remote ischemic conditioning may play a renal protective effect by upregulating the expression of HO-1.