中性粒细胞明胶酶相关脂质运载蛋白对轻中度肾衰竭患者对比剂急性肾损伤的预测价值

Prediction of plasma neutrophil gelatinase-associated lipocalin for contrast induced acute kidney injury

目的:评价血浆中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated li-pocalin,NGAL)在对比剂急性肾损害(contrast induced acute kidney injury,CIAKI)早期诊断价值。方法:连续入选拟行冠状动脉造影及支架植入术的患者。包括稳定型心绞痛及除急性ST段抬高性心肌梗死外的急性冠状动脉综合征患者;按照适合中国人的肾脏疾病饮食调整公式(Modified diet in renal dis-ease,MDRD)公式评价肾功能,选择30≤eGFR<90 mL.min-1.1.73 m-2的患者。CIAKI定义为:PCI术后48～72 h,SCr升高44.2 mmol/L(0.5 mg/dL)或升高25%。术前及术后4 h血浆NGAL采用ELISA方法检测,评价NGAL对CIAKI的预测价值。结果:共入选患者311例,其中39例(12.5%)患者发生了CIAKI。术前及术后4 h血浆NGAL水平的曲线下面积(area under the ROC curve,AUC)分别为(0.567,95%CI:0.465～0.668,P=0.210)和(0.662,95%CI:0.565～0.758,P=0.002)。结论:血浆NGAL可以作为CIAKI的早期诊断标志物,阴性诊断价值更大。

Objective：To evaluate the Neutrophil Gelatinase-Associated Lipocalin（NGAL） for early prediction of Contrast Induced Acute Kidney Injury（CIAKI）.Methods： The patients with established or suspected coronary artery disease were continuously enrolled in our study.The estimated glomerular filtration rate（eGFR） was more than 30 mL/min/1.73 m2 and nor more than 90 mL/min/1.73 m2 according to the formula of modified diet in renal disease（MDRD）.The blood was obtained before and 4 hours after procedure for the plasma NGAL measure used ELISA kit.CIAKI was defined as a relative increase in serum creatinine（SCr） from baseline of≥25% or an absolute increase of≥0.5 mg/dL（44 μmol/L） up to day 3.Results： Total of 311 patients was enrolled,among whom 39（12.5%） developed CIAKI.The area under the ROC curve（AUC） of plasma NGAL was 0.567（0.465-0.668,P=0.210）and 0.662（95%CI： 0.565-0.758,P=0.002）before and after procedure,respectively.The negative predictive value was more than 90%.Conclusion： Plasma NGAL might be useful biomarker for prediction of CIAKI with higher negative predictive value.