目的:探讨血和尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对成人心脏术后急性肾损伤(AKI)的早期诊断价值。方法:收集112例心脏手术患者手术前后不同时相的血、尿标本,分别测定血肌酐(Scr)、血NGAL和尿NGAL。根据AKI的诊断标准,将患者分为AKI组和非AKI组,观察两组Scr、血NGAL和尿NGAL的动态变化。用受试者工作特征曲线(ROC)评价血NGAL和尿NGAL对AKI的诊断价值。结果:112例患者中21例术后24 h Scr水平上升至基础值的1.72倍,AKI发生率为18.8%。AKI组术后2 h血NGAL开始显著增高并达到峰值,与基线值比较差异有统计学意义[分别为(82.2±22.3) ng·ml-1和(16.9±3.1) ng·ml-1,P<0.05];尿NGAL较基线值明显上升[分别为(132.4±41.1) ng·ml-1和(30.8±23.1) ng·ml-1,P<0.05],并在术后4 h达到峰值。AKI组术后2 h,血NGAL诊断AKI的ROC曲线下面积为0.866,95%的可信区间为0.756~0.976,以19 ng·ml-1作为AKI的诊断界限时,敏感性和特异性分别为85.7%和88.4%;尿NGAL的ROC曲线下面积为0.914,95%的可信区间为0.86~0.966,以56 ng·ml-1作为AKI的诊断界限时,敏感性和特异性分别为95.2%和88.4%。结论:心脏手术后2 h的血、尿NGAL水平对AKI具有预测价值,其出现变化时间远早于Scr;血、尿NGAL可作为心脏术后并发AKI患者的早期诊断的标记物。 |
[1] THAKAR C V,WORLEY S,ARRIGAIN S,et al.Improved survival in acute kidney injury after cardiac surgery[J].Am J Kidney Dis,2007,50(5):703-711.
[2] HOSTE E A,SCHURGERS M.Epidemiology of acute kidney injury: how big is the problem?[J].Crit Care Med,2008,36(4 Suppl):146-151.
[3] BAGSHAW S W,GIBNEY R T.Conventional markers of kidney function[J].Crit Care Med,2008,36(4 Suppl):S152-S158.
[4] MISHRA J,MA Q,PRADA A,et al.Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury[J].J Am Soc Nephrol,2003,14(10):2534-2543.
[5] 张莉,刘佳,孙彬,等.急性肾衰竭64例临床病理学分析[J].东南大学学报:医学版,2009,28(4):325-328.
[6] MISHRA J,MA Q,KELLY C,et al.Kidney NGAL is a novel early marker of acute injury following transplantation[J].Pediatr Nephrol,2006,21(6):856-863.
[7] MEHTA R L,KELLUM J A,SHAH S V,et al.Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury[J].Crit Care,2007,11(2):R31-R39.
[8] CHERTOW G M,BURDICK E,HONOUR M,et al.Acute kidney injury,mortality,length of stay,and costs in hospitalized patients[J].J Am Soc Nephrol,2005,16(11):3365-3370.
[9] WAIKAR S S,BONVENTRE J V.Biomarkers for the diagnosis of acute kidney injury[J].Curr Opin Nephrol Hypertens,2007,16(6):557-564.
[10] COCA S G,YALAVARTHY R,CONCATO O,et al.Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review[J].Kidney Int,2008,73(9):1008-1016.
[11] DOI K,YUEN P S,EISNER C,et al.Reduced production of creatinine limits its use as marker of kidney injury in sepsis[J].J Am Soc Nephrol,2009,20(6):1217-1221.
[12] DEVARAJAN P.NGAL in acute kidney injury: from serendipity to utility[J].Am J Kidney Dis,2008,52(3):395-399.
[13] DEVARAIAN P.Neutrophil gelatinase-associated lipocalin: an emerging troponin for kidney injury[J].Nephrol Dial Transplant,2008,23(12):3737-3743.
[14] COWLAND J B,BORREGAARD N.Molecular characterization and pattern of tissue expression of the gene for neutrophil gelatinase-associated lipocalin from humans[J].Genomics,1997,45(1):17-23.
[15] MISHRA J,CATHENNE D,RIDUAN T,et al.Neutrophil gelatinase-associated lipocalin(NGAL) as a biomarker for acute renal injury after cardiac surgery[J].Lancet,2005,365(9466):1231-1238.
[16] MISHRA J,MA Q,PRADA A,et al.Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury[J].J Am Soc Nephrol,2003,14(10):2534-2543.
[17] HAN W K,WAIKAR S S,JOHNSON A,et al.Urinary biomarkers in the early diagnosis of acute kidney injury[J].Kidney Int,2008,73(7):863-869.
[18] WHEELER D S,DEVARAJAN P,MA Q,et al.Serum neutrophil gelatinase-associated lipocalin(NGAL) as a marker of acute kidney injury in critically ill children with septic shock[J].Crit Care Med,2008,36(4):1297-1303.
[19] BACHORZEWSKA-GAJEWSKA H,PONIATOWSKI B,DOBRZYCKI S.NGAL(neutrophil gelatinase-associated lipocalin) and L-FABP after percutaneous coronary interventions due to unstable angina in patients with normal serum creatinine[J].Adv Med Sci,2009,54(2):221-224. |