NGAL与急性有机磷农药中毒急性肾损伤相关性研究

Correlation between NGAL and acute kidney injury caused by acute organophosphorus pesticide poisoning

目的探讨血清明胶酶相关脂质运载蛋白(NGAL)检测在急性有机磷农药中毒(AOPP)所致急性肾损伤(AKI)诊断、病情判断中的临床价值。方法根据临床症状、乙酰胆碱酯酶活力及浓度将105例AOPP患者分为轻度组(35例)、中度组(38例)、重度组(32例),以50例体检健康者作为对照组。分别检测对照组及不同中毒程度组入院时、入院后1、3、5d血清NGAL、肌酐(Scr)水平,分析AOPP患者NGAL阳性率、诊断AKI灵敏度和特异度,及其与中毒程度、持续时间的相关性。结果 AOPP患者AKI发病率为86.7%;入院后1d内NGAL阳性率高达76.2%,与中毒程度呈正相关(P<0.05)。NGAL水平在入院后1d达峰值,随后开始下降。结论 AOPP患者AKI发病率高;NGAL是诊断AOPP早期AKI的理想指标,特异度为100.0%,灵敏度也较高;NGAL浓度、阳性率与AOPP中毒程度呈正相关。

Objective To explore the clinical value of serum neutrophil gelatinase-associated lipocalin（NGAL） for the diagnosis and the evaluation of pathogenetic condition of acute kidney injury（AKI） caused by acute organophosphate pesticide poisoning（AOPP）.Methods 105 patients with AOPP were divided into three groups,including moderate group（n=35）,midrange group（n=38） and severity group（n=32）,according to clinical symptom and the activity and concentration of acetylcholinesterase（AchE）.Fifty healthy subjects were enrolled as control group.Serum NGAL and creatinine were detected in control group,and in patient groups on the admission and 1,3 and 5 d after admission.The positive rate of NGAL in patients with AOPP,the diagnostic sensitivity and specificity of NGAL for AKI and the correlation between NGAL and the degree and persistence time of intoxication were analyzed.Results The incidence of AKI caused by AOPP was 86.7%.The positive rate of NGAL,detected 1 d after admission,was 76.2%,and was positively related with intoxication degree.Serum level of NGAL raised to the peak value in 1 d after admission then decreased.Conclusion Incidence of AKI caused by AOPP is 86.7%.The incidence rate of AKI caused by AOPP might be high.NGAL could be ideal indicator for the diagnosis of AKI in patients with AOPP,with specificity of 100.0% and high sensitivity.The concentration and positive rate of NGAL could be positively related with the intoxication degree of AOPP.