危重患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白浓度的测定及其临床意义

Measurement and clinical significance of plasma neutropil gelatinase-associated lipocalin concentration in critically ill patients

目的 探讨检测危重患者血浆中的中性粒细胞明胶蛋白酶相关载脂蛋白（NGAL）的浓度及其临床意义.方法 选择23名健康成人作为对照组,54例ICU危重患者作为试验组.动态监测血浆NGAL和C反应蛋白（CRP）浓度,同时进行急性生理学和慢性健康评估（APACHE）Ⅱ评分,并观察预后.血浆中NGAL浓度的测定采用酶联免疫吸附法.结果 试验组患者的NGAL浓度平均为（7.62±3.89）ng/L,对照组为（3.40±0.50）ng/L;试验组CRP浓度平均为（68.90±79.58）mg/L,对照组为（1.73±1.13）mg/L.最终存活的37例患者进入本研究时,平均的APACHEⅡ评分为（13.27±7.02）分,NGAL为（7.61±3.42）ng/L,CRP为（74.48±80.94）mg/L,白蛋白（29.06±6.76）g/L.最终死亡的17例患者进入本研究时,平均的APACHEⅡ评分为（24.59±8.78）分,NGAL为（8.91±4.79）ng/L,CRP为（94.00±115.88）mg/L,白蛋白（30.26±9.68）g/L.危重患者血浆NGAL、CRP浓度明显高于健康成人（P＜0.01）;最终完成2次取样的24例好转患者治疗后血浆NGAL浓度、APACHEⅡ分值均明显下降（P＜0.01）;7例病情恶化最终死亡的患者治疗第7天血浆NGAL浓度显著升高（P=0.02）,而APACHEⅡ分值治疗后较入ICU时有所升高,但差异无统计学意义.入ICU时,最终存活的37例患者和最终死亡的17例患者的NGAL浓度差异无统计学意义（P=0.259）,而APACHEⅡ分值则差异有统计学意义（P＜0.01）.结论 危重患者血浆NGAL浓度明显高于健康成人.NGAL浓度动态变化可能反映病情的变化,如结合APACHEⅡ评分,有助于更早更准确地评估病情变化,对提高危重患者的抢救成功率具有重要意义.

Objective To detect the concentration of plasma neutrophil gelatinase-associated lipocalin （NGAL） and the clinical significance in critically ill patients. Methods Fifty-four critically ill patients in ICU were enrolled in the present study with 23 health persons as controls. Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay （ELISA） on the 1 st and 7th day from 54 adult patients in ICU and the controls （control group）. Results The plasma NGAL concentrations of ICU patients were significantly higher than those of the controls （P 〈0.001 ）. NGAL concentrations were no significant difference between the Death group and the Survival group on the 1 st day（P = 0. 259）. But there was a markedly significant difference in Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores （P 〈0. 001 ）. The APACHE Ⅱ scores on the 7th day significantly decreased in the improved patients （P =0.019） and showed a subtle tendency of increase in the deteriorated patients （ P =0.403） in comparison to the first day. The plasma NGAL levels followed the same trends, but showing a significant increase even in deteriorated patients （ P = 0. 016 and P= 0. 034, respectively）. Conclusions The plasma NGAL concentrations of critically ill patients is significantly increased. Combined with APACHE Ⅱ scores,it can provide useful and available data of the disease state of critically ill patients.