中性粒细胞明胶酶相关脂质转运蛋白在小儿烧伤急性肾损伤中的意义

Neutrophil gelatinase associated lipocalin in prediction of acute kidney injury in childrenwith burn

目的：观察小儿烧伤后中性粒细胞明胶酶相关脂质转运蛋白（NGAL）的水平变化，探讨NGAL对小儿烧伤急性肾损伤（AKI）的临床意义。方法：选取47例烧伤患儿，检测其血常规、尿常规、血清肌酐（Scr）、血NGAL、尿NGAL、尿素氮（BUN）、C反应蛋白（CRP）水平，根据Scr和尿量变化诊断AKI，同时纳入30例健康同龄儿童作为对照组。比较AKI组、非AKI组和对照组3组各项生化指标并通过受试者工作特征曲线（ROC）分析血NGAL、尿NGAL和Scr在AKI诊断应用中的特异性和敏感性。结果：AKI组血、尿NGAL水平在入院当天显著升高（P ＜0．05），而Scr水平与非AKI组和对照组差异无统计学意义（P ＞0．05）。 AKI组血、尿NGAL在入院当天与WBC和CRP呈正相关（P ＜0．05），在入院第7天与Scr呈正相关（P ＜0．05）。ROC曲线显示血NGAL、尿NGAL和Scr在烧伤患儿入院当天诊断AKI的曲线下面积（AUC）分别是0．737（95％CI：0．653～0．779，P ＜0．05）、0．772（95％CI：0．632～0．793，P ＜0．05）、0．508（95％CI：0．454～0．618， P ＜0．05）。当血NGAL为318μg／L时，其诊断的敏感性为72．8％，特异性为81．6％；当尿NGAL为105μg／L时，其诊断的敏感性为75．6％，特异性为83．7％。结论：小儿烧伤后血、尿NGAL水平升高早于Scr，血、尿NGAL可作为早期预测小儿烧伤AKI的指标。

Objective To evaluate the levels of neutrophil gelatinase associated lipocalin （NGAL） in prediction of acute kidney injury （AKI） in children with burn. Methods Forty seven children with burn were selected in this study and thirty healthy children were enrolled as a control group. Levels of blood routine, urine routine, serum creatinine （Scr）, serum NGAL （SNGAL）, urine NGAL （UNGAL）, blood urea nitrogen （BUN） and C-reactive protein （CRP） were measured. Receiver operating characteristic （ROC） curve were used to estimate the AKI diagnostic value of serum NGAL, urine NGAL and Scr. Results On the day of admission, serum NGAL and urine NGAL were significantly increased in patients with AKI , while Scr did not change significantly as compared with those in non-AKI patients and the healthy controls. In AKI group, serum NGAL and urine NGAL were positively correlated with WBC and CRP on the day of admission , and positively related with Scr on the seventh day. ROC analysis showed the AUC of serum NGAL, urine NGAL and Scr on admission were 0.737（95%CI： 0.653 ~ 0.779, P 〈 0.05）, 0.772（95%CI： 0.632 ~ 0.793, P 〈 0.05）, and 0.508（95%CI： 0.454~0.618, P 〈 0.05） respectively. The cut-off value of serum NGAL and urine NGAL were 318 μg/L （sensitivity of 72.8% and specificity of 81.6%） and 105 μg/L （sensitivity of 75.6% and specificity of 83.7%）. Conclusions Elevation in levels of serum NGAL and urine NGAL occurs earlier than that in Scr level in children with burn. Both serum and urine NGAL level can be used as a biomarker for early prediction of AKI.