尿NGAL和KIM-1在儿童急性肾损伤中的改变及临床意义

Changes of Urinary Neutrophil Gelatinase-associated Lipocalin and Kidney Injury Molecule-1 in Children with Acute Kidney Injury

目的评价尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)和N-乙酰-β-D氨基葡萄糖苷酶(NAG)在不同基础疾病导致急性肾损伤(AKI)儿童中的改变及其临床意义。方法将在我院门诊和急诊进行肾功能检测且既往1年内曾因不同原因在我院进行过肾功能检测的无慢性肾脏疾病的患儿纳入本研究。入选患儿留取5 mL尿液。采用ELISA方法检测尿NGAL和KIM-1,记录患儿原发疾病、住院患儿的住院时间。以AKI pRIFLE为分期标准,将诊断为AKI的患儿分为AKI-R组、AKI-I组和AKI-F组。结果共552名患儿纳入本研究,其中住院患儿316名,诊断为AKI的患儿59名。AKI组患儿尿NGAL、KIM-1和NAG值明显高于肾功能正常组(P<0.05),在血肌酐未升高前这3项指标均已升高,且随着肾损伤的加重升高更明显。住院AKI患儿中,AKI越严重,住院时间越长。结论儿童AKI的发生不仅源于肾脏疾病本身,还可源于其他系统疾病。尿NGAL和KIM-1在AKI早期已经明显升高,在AKI诊断上较血肌酐敏感,尿NGAL和KIM-1较尿NAG值升高显著,可以作为儿童不同基础疾病导致AKI的早期诊断指标。

Objective To determine the function of neutrophil gelatinase-associated lipocalin（NGAL） and kidney injury molecule-1（KIM-1） in children acute kidney injury（AKI） prediction.Methods A prospective single-center evaluation of urinary biomarkers was performed in a cohort of children who presented to Shengjing Hospital Pediatric Clinic and Emergency center from June 2009 to December 2010.Patients were included if the physician ordered a serum creatinine and had been done serum creatinine within one year.Patients with a known diagnosis of chronic kidney disease were excluded.Five mL of urine was obtained for assessment of NGAL and KIM-1 by ELISA method.Patients were classified by the pediatric modified RIFLE（pRIFLE） criteria for AKI.The primary diagnosis and length of hospitalization were also recorded.Results A total of 552 patients were enrolled in the study,316 patients were hospitalized,59 patients were diagnosed AKI.Patients with AKI had a significantly elevated mean urinary NGAL and KIM-1 level compared with normal kidney function patients.AKI-F patients had the highest value of urinary NGAL and KIM-1 and significant statistical difference was found when comparing with normal groups（329.1±366.2,13.9±12.7,and 1129.0±1018.7,280.2±218.6,P 0.001）.These values were superior to those for NAG and serum creatinine.Some patients with AKI-R and AKI-I had normal value of serum creatinine and significantly elevated urinary NGAL and KIM-1.The length of hospitalization for the children was correlated with the severity of AKI.Conclusion Pediatric AKI is not only caused by kidney disease but also by other diseases.Urinary NGAL and KIM-1 were significantly elevated in the children with early stage AKI,which may serve well to detect AKI accurately even in cases where serum creatinine levels are normal.