血中性粒细胞明胶酶相关脂质运载蛋白对ICU中急性肾损伤的早期诊断价值

Study on clinical significance of plasma neutrophil gelatinase-associated lipocalin in early diagnosis of acute kidney injury in ICU

目的研究检测血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对重症患者急性肾损伤(AKI)的早期诊断价值。方法以2011年1月到2011年9月收入首都医科大学附属复兴医院ICU的重症患者作为研究对象,登记患者284例,最终有268例患者纳入研究,其中AKI组112例,非AKI组156例,并选取40例健康体检者作为健康对照组。研究组留取患者入选时血样和入选后1～4 d血样,用酶联免疫吸附法(ELISA)检测血清NGAL(pNGAL)水平。用受试者工作特征曲线(ROC)评价pNGAL对AKI的早期诊断作用以及预测需肾脏替代治疗(RRT)和AKI严重程度的关系。结果血NGAL可以诊断入ICU后48 h内的AKI发生,ROC曲线下面积为0.82(95%CI 0.68～0.93);预测RRT的使用,ROC曲线下面积为0.84(95%CI 0.73～0.95);与AKI的严重程度密切相关(R=0.554,P<0.001)。结论在成人普通ICU中血NGAL可以成为AKI的早期诊断标记物,能预测RRT的使用,与AKI的严重程度密切相关。

Objective To study the significance of plasma neutrophil gelatinase - associated lipocalin （pNGAL） in early diagnosis of acute kidney injury （AKI） in critically ill patients. Methods A total of 268 adult patients in ICU of this hospital during January 2010 to September 2010 were allocated for this study. Among them, 112 patients met with RIFLE（ Risk, Injury, Failure, Loss of kidney function, and End - stage kidney disease）criteria were selected as AKI group, 156 patients without AKI were listed in non - AKI group and 40 healthy persons were enrolled as control group. Blood samples for NGAL were collected daily from ICU during admission and up to 4 days of hospitalization. The plasma level of NGAL was determined by enzyme -linked immunosorbent assay （ELISA）. The receiver operating characteristic （ROC） curve was used to evaluate the significance of pNGAL in early diagnosis and need for renal replacement therapy （RRT） and correlation with the severity of AKI. Results Plasma NGAL was a good diagnostic marker for development of AKI within next 48h, the area under the curve （ AUC ） of pNGAL was 0. 82 （95 % CI 0.68 - 0.93 ）, and for application of RRT, the area under the curve （ AUC ） of pNGAL was 0.84 （ 95 % CI 0.73 - 0.95 ）, and it correlated well with severity of AKI （ R = 0. 554, P 〈 0. 001 ）. Conclusion Plasma NGAL is an useful early marker for AKI in ICU, it predicts the need for renal replacement therapy （RRT） and correlates with the severity of AKI.