检测中性粒细胞明胶酶脂质运载蛋白早期诊断体外循环术后急性肾损伤

Neutrophil gelatinase-associated lipocalin detection for early diagnosis of acute kidney injury after cardiopulmonary bypass

目的探讨中性粒细胞明胶酶脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）在体外循环术后急性肾损伤（acute kidney injury,AKI）早期诊断中应用。方法选择120例进行体外循环手术的先天性心脏病患者,体外循环结束后第一个12 h内采集尿样及血样1次/2 h,此后3 d内采集1次/12 h,采用ELISA方法对尿样中NGAL进行定量分析,同时测定血清肌酐基线水平,并在术后相应时间点检测血清肌酐水平,血清肌酐比基线水平增加50%以上为发生AKI的标准。结果术后3 d内有21例发生不同程度AKI,发生率17.5%,AKI组在体外循环术后各时间点尿NAGL浓度都显著升高,以术后2~6 h最为显著,两组比较有显著性差异,对术后2 h的尿NAGL浓度在界限值为100μg/L时进行ROC分析,尿NAGL在AKI诊断中的敏感性和特异性分别为96%和93%。结论尿NAGL可以作为体外循环术后AKI的预测指标,在诊断AKI时较血清肌酐早,有利于早期对AKI进行预防和干预。

Objective To evaluate the value of neutrophil gelatinase-associated lipocalin（NAGL） detection for early diagnosis of acute kidney injury（AKI） after cardiopulmonary bypass.Method The 120 children undergoing cardiopulmonary bypass were enrolled in this prospective study.Serial urine samples were analyzed by ELISA for evaluating NGAL expression.The primary detection of AKI was defined as a 50% or greater increase in serum creatinine from baseline.Result Among 120 cases 21 children（17.5%） developed AKI.Urine concentrations of NGAL rose later 2 h after cardiopulmonary bypass.By multivariate analysis,the amount of NGAL in urine at 2 h after cardiopulmonary bypass was the most powerful independent predictor of AKI.For concentration in urine of NGAL at 2 h,the area under the receiver-operating characteristic curve was 0.994,sensitivity was 96%,and specificity was 93% for a cutoff value of 100 μg/L.Conclusion Concentrations in urine of NGAL represent sensitive,specific,and highly predictive early biomarkers for acute renal injury after cardiopulmonary bypass.