休克患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白的检测与临床意义

Measurement and clinical significance of plasma neutruphil gelatinase associated lipocalin concentration in shock patients

目的探讨休克患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白（NGAL）的浓度及其临床意义。方法人选ICU内38例危重患者作为观察对象。动态检测血浆中NGAL浓度，同时进行急性生理和慢性健康评分Ⅱ（APACHEⅡ）及序贯性器官衰竭估计（SOFA）评分，并记录预后。血浆NGAL浓度的测定采用酶联免疫吸附测定。用受试者工作特征曲线评价血浆NGAL水平对死亡的预测作用，计算ROC曲线下面积及其95％置信区间（凹）。结果38例危患者入ICU时出现休克10例（休克组），未出现休克患者28例（非休克组）；住院期间恶化17例（恶化组），好转21例（好转组）。人ICU时，休克组血浆NGAL浓度、血清肌酐、血糖和凝血酶原时间国际标准化比值均高于非休克组[分别为（147±113）μg／L比（59±64）μg／L，（201±93）pomol／L比（132±106）μmol／L，（13．5±6．1）mmol／L比（9．0±3．0）mmool／L，（1．23±0．33）比（1．00±0．12）]；差异均有统计学意义（P〈0．05或P〈0．01）；HC03-和血小板计数明显低于非休克患者[分别为（18±5）mmol／L比（25±6）mmol／L，（115±61）×10^9／L比（161±57）×10^9／L]，差异均有统计学意义（P〈0．05）。恶化组血浆NGAL浓度、APACHEII和SOFA评分均明显高于好转组[分别为（113±105）μg／L比（51±35）μg／L，（26±7）分比（194-6）分，（10．24-3．0）分比（6．6±3．0）分]，差异均有统计学意义（P〈0．05或P〈0．01）。血浆NGAL水平、APACHEⅡ和SOFA评分对患者死亡预测的受试者工作特征曲线下面积分别为0．717（95％口为0．550—0．884，P〈0．05）、0．770（95％CI为0．616～0．925，P〈0．01）和0．796（95％CI为0．650～0．937，P〈0．01），以NGAL=79．56μg／L作为预测死亡临界点，其敏感度为52．9％、特异度为90．5％。结论联合血浆NGAL水平和APACHEⅡ或SOFA评分可能有助于评价休克患者病情严重度及预后。

Objective To detect the concentration of plasma neutrophil gelatinase associated lipocalin （NGAL） and it＇s clinical significance in shock patients. Methods All 38 patients in intensive care unit（ICU） were enrolled. Serial blood samples were drawn from patients for NGAL measuring and acute physiology and chronic health evaluation （APACHE） Ⅱ and sequential organ failure assessment （SOFA） score were performed. Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay （ELISA）. Results Of 38 cases, 10 pa- tients were shock cases, another 28 cases with non-shock when admitted to the hospital, and 17 patients got worse and 21 patients were improved in hospital. Compared with non-shock patients, plasma NGAL, serum creatinine, blood glucose and prothrombin time-international normal ration （PT-INR） of shock patients were higher [ （147 ± 113 ）μg/L vs （59± 64 ） μg/L, （201 ±93 ） μmol/L vs （132 ±106 ） μmol/L, （13.5 ± 6. 1 ）mmol/L vs （9.0 ±3.0） mmol/L, （ 1.23 ± 0. 33） vs （ 1.00 ± 0. 12）, respectively ] ; bicarbonate radical （ HCO3- ） and platelet were lower [ （ 18 ± 5 ） mmol/L vs（25 ± 6） mmool/L, （ 115 ± 61 ） × 109/L vs （ 161 ± 57 ） × 109/L, respectively ] when admitted to ICU （P〈O. 05 or P 〈0. 01 ）. Areas under the receiver operating characteristic curves （ROC curves） of NGAL, APACHE lI and SOFA scores for hospital mortality were 0. 717 [95% confident interval（CI） 0. 550-0. 884, P 〈 0. 05 ], 0. 770 （95% CI 0. 616-0. 925, P 〈 0. 01 ） and 0. 796 （ 95% CI 0. 650-0. 937, P 〈 0. 01 ）. Plasma NGAL concentration greater than 79. 56 μg/L was an indicator for mortality; the sensitivity and the specificity was 52.9% and 90. 5% respectively. Conclusion Combining the plasma NGAL levels with APACHE Ⅱ or SOFA score may contribute to evaluation of the severity and prognosis of shock patients.