尿中性粒细胞明胶酶相关脂质运载蛋白对百草枯中毒患者急性肾损伤早期诊断的意义

Urinary neutrophil gelatinase-associated lipocalin （uNGAL） and early diagnosis of paraquat poisoning patients with acute kidney injury （AKI）

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）对百草枯中毒患者急性肾损伤（AKI）的早期诊断价值。方法以我院急诊科收治的85例患者为观察对象，收集百草枯中毒入院后即刻（15min内）及2,4、6、8、10、12、18、24、36、48及72h，5和7d时的血、尿液标本各5ml，用酶联免疫吸附（ELISA）法检测尿中uNGAL水平。同时用肌氨酸氧化酶法测定血清肌酐（SCr）水平。结果百草枯中毒患者中发生AKI62例，发生率为72．94％（62／85）。AKI患者18、24、36、48、72h及5、7d各时间点的SCr水平明显上升，与基线值和对照组比较，差异有统计学意义（P〈0．01）。AKI组24、36、48、72h及5、7d各时间点的SCr水平与非AKI组比较，差异有统计学意义（P〈0．01）。百草枯中毒AKI组2h尿中uNGAL即明显高于基线值，达（96．21±45．32）μg／L。4、6、8、10、12、18、24、36、48、72h及5、7d各时间点百草枯中毒AKI组患者尿中uNGAL水平呈逐渐升高的趋势，与对照组和基线值比较，差异均有统计学意义（P〈0．01）。与对照组和基线值比较，12、18、24、36、48、72h及5、7d各时间点非AKI组尿中uNGAL水平明显升高，差异有统计学意义（P〈0．05）。各时间点百草枯中毒AKI组尿中uNGAL水平均明显高于非AKI组，差异有统计学意义（P〈0．01）。结论百草枯中毒后2h尿中uNGAL水平明显升高，其诊断AKI的时间早于SCr。尿中uNGAL可作为百草枯中毒后AKI的早期诊断标志物。

Objective To explore the use of the urinary neutrophil gelatinase associated lipocalin （uNGAL） in the early diagnosis of paraquat poisoning patients with acute kidney injury （AKI）. Methods Eighty five patients were from the emergency department in our hospital. Five ml blood and urine were collected from each patient at 15 min, 2, 4, 6, 8, 10, 12, 18, 24, 36, 48 and 72 h, 5 and 7d after admission. The uNGAL levels of urine were detected with ELISA test and the SCr levels were measured with creatine oxidase assay. Results Sixty two cases of paraquat intoxication suffered from AK1, the incidence was 72.94% （62/85）. The SCr levels of 62 cases with AKI at 18, 24, 36, 48, 72 h and 5, 7 d after admission increased significantly, as compared with the baseline value and control group （P〈0.01）. At 24, 36, 48, 72 h and 5, 7 d after admission, there was significant difference of the SCr levels between AKI group and non- AKI group （P〈0.01）. At 2 h after admission, the uNGAL level of urine in paraquat intoxication AKI group was （96.21±45.32） μg/L which was significantly higher than the baseline value. At 10, 12, 18, 24, 36, 48, 72 h and 5, 7 d after admission, the uNGAL levels of urine in AKI group and non-AKI group obviously enhanced, as compared with the baseline value and control group （P〈0.01 or P〈0.05）. At all time points, there was significant difference of the uNGAL level between AKI group and non-AKI group （P〈0.01）. Conclusion The uNGAL level of urine in paraquat intoxication patients at 2 h after admission significantly enhanced, which is earlier than enhanced SCr. So the uNGAL level of urine may serve as early diagnostic biomarker for AKI induced by paraquat intoxication.