血清中性粒细胞明胶酶相关脂质运载蛋白检测在急性肾功能损伤早期诊断中的临床意义

Clinical significance of serum neutrophil gelatinase-associated lipocalin detection in early diagnosis of acute kidney injury

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)检测在急性肾功能损伤(AKI)早期诊断中的意义。方法收集无慢性肾病的重症监护病房(ICU)、冠心病监护病房(CCU)患者60例,分别在其术前及术后6、12、48 h采集血样,其中27例发生AKI(AKI组),以其余33例未发生AKI(无AKI组)。应用酶联免疫吸附试验(ELISA)检测血清NGAL浓度,碱性苦味酸法检测血清肌酐(SCr)浓度,胶乳增强免疫浊度法检测血清半胱氨酸蛋白酶抑制剂C(Cys C)浓度。以48 h内SCr高于基础水平50%作为AKI的诊断标准,应用受试者工作特征(ROC)曲线评估NGAL在AKI早期诊断中的效力。结果与术前比较,AKI组术后6、12、48 h的血清NGAL明显升高,Cys C在术后12、48 h明显升高,而SCr在术后48 h才显著升高。无AKI组术前与术后6、12、48 h的NGAL、SCr、Cys C浓度差异无统计学意义(P>0.05)。术后6、12、48 h血清NGAL的ROC曲线下面积为0.51[95%可信区间(CI):0.25～0.78]、0.80(95%CI:0.58～0.95)、0.85(95%CI:0.61～0.99)。结论血清NGAL在术后6 h上升,术后12 h即能较好地预测AKI,其预测AKI时间早于Cys C和SCr。血清NGAL可能在AKI早期诊断中有良好的应用价值。

Objective To investigate the clinical significance of serum neutrophil gelatinase-associated lipocalin（NGAL） detection in early diagnosis of acute kidney injury（AKI）.Methods A total of 60 inpatients in intensive care unit（ICU） and coronary care unit（CCU） without chronic kidney diseases were enrolled.Sera were collected before surgery and 6,12 and 48 h after surgery respectively.There were 27 AKI patients and other 33 patients without AKI.The concentration of NGAL was determined by enzyme-linked immunosorbent assay（ELISA）.Serum creatinine（SCr） was detected by Jaffé reaction method.Serum cystatin C（Cys C） was detected by Latex-enhanced immunoturbidimetry.AKI was defined as an increase in SCr of at least 50% from baseline within 48 h.The efficiency of NGAL in early diagnosis of AKI was evaluated by receiver operating characteristic（ROC） curve.Results Serum NGAL increased significantly 6,12 and 48 h after surgery,while serum Cys C increased 12 and 48 h after surgery,and SCr increased 48 h after surgery in the AKI group.There was no obvious difference in the concentrations of NGAL,SCr and Cys C in the non-AKI group before and 6,12 and 48 h after surgery（P0.05）.By ROC curve analysis,serum NGAL 6 h after surgery had an area under the curve of 0.51 [95% confidence interval（CI）： 0.25-0.78],serum NGAL 12 h after surgery had an area under the curve of 0.80（95%CI： 0.58-0.95）,and serum NGAL 48 h after surgery had an area under the curve of 0.85（95%CI： 0.61-0.99）.Conclusions Serum NGAL increases 6 h after surgery and predicts AKI accurately 12 h after surgery.For predicting AKI,serum NGAL is earlier than Cys C and SCr,and shows that serum NGAL can be as potential marker for the early diagnosis of AKI.