尿液生物学标记物对肝移植患者术后急性肾损伤早期诊断的价值

The early diagnosis of acute kidney injury after liver transplantation by urine lactate dehydrogenase, cystatin C and neutrophil gelatinase-associated lipocalin

目的 探讨尿液中乳酸脱氢酶（lactate dehydrogenase, LDH）、胱抑素C（cystatin C , Cys-C）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase–associated lipocalin，NGAL）对于肝移植患者术后急性肾损伤（acute kindey injury，AKI）早期诊断价值。方法 收集2011年1月至2011年10月在南方医院接受同种异体肝移植术的45例终末期肝病患者术前及手术结束时的静脉血液及尿液标本，检测血清肌酐（serum creatinine, SCr）、胱抑素、LDH及总胆红素，检测尿液中LDH、胱抑素、NGAL。根据AKI网络标准中的SCr标准将患者分为AKI组和非AKI组。比较两组术前、术后尿液中LDH、Cys-C、NGAL的变化情况，并运用受试者工作曲线（receiver operating characteristic curve, ROC）评价LDH、Cys-C、NGAL的准确性。结果 45例患者中20例发生了术后AKI，两组患者的年龄、性别、术前的基本情况、术中手术情况比较差异无统计学意义。AKI组和非AKI组术后血清SCr的差异具有统计学意义[（140±54）比（81±20）, P〈0.05]。术后AKI组及非AKI组尿液中的LDH、Cys-C、NGAL均升高，AKI组增加明显高于非AKI组。AKI组尿液中LDH、Cys-C、NGAL高于非AKI组，且差异具有统计学意义[（6.50±2.86）比（3.21±1.63），P〈0.05]、[（1.55±0.54）比（0.86±0.31），P〈0.05]、[（107±59）比（43±11），P〈0.05]。ROC下面积结果显示，尿液中的LDH、Cys-C、NGAL均显示出了较好的诊断意义，面积分别为0.853、0.833、0.880，大于0.8。结论 LDH、Cys-C、NGAL均表现出了较好的敏感性和特异性。

Objective To investigate the value of urinary lactate dehydrogenase（LDH）, Cystatin C （Cys-C） and neutrophil gelatinase-associated lipocalin （NGAL） in early diagnosis of acute kidney injury after liver transplantation. Methods From January 2011 to October 2011, 45 patients were recruited. Blood and urinary samples were collected before operation and the end of the operation, and used to determine serum creatinine （SCr）, Cys-C, LDH, and total bilirubin, as well as urinary LDH, Cys-C and NGAL. All the patients were divided into AKI and non-AKI groups, according to the Acute Kidney Injury Network （AKIN） criteria of AKI. The statistics were used along ROC analysis to evaluate the diagnose value of selected biomarkers. Results There were no significant differences in clinical parameters between AKI and non-AKI groups while 20 of the 45 patients suffered AKI[（140±54）vs（81±20）,P〈0.05]. Urine LDH, Cys-C and NGAL raised in all the samples, and the level of the 3 enzymes in AKI group increased significantly [（6.50±2.86）vs（3.21±1.63）,P〈0.05],[（1.55±0.54）vs（0.86±0.31）,P〈0.05],[（107±59）vs（43±11）,P〈0.05]. ROC analysis revealed that （AUC 0.853, 0.833, 0.880） the 3 enzymes are capable of early diagnosis of AKI. Conclusions Urinary LDH, Cys-C and NGAL appear to be sensitive and specific biomarkers of AKI in liver transplant recipients, but further research are needed in the future for the clinical diagnosis.