NGAL对心脏瓣膜置换术后急性肾损伤的早期诊断价值

Value of neutiophil gelatinase-associated lipocalin in early diagnosis of acute kidney injury following adult valvular heart surgery

目的探讨血、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在心脏瓣膜置换术后急性肾损伤（AKI）中的早期诊断价值。方法前瞻性收集56例接受心脏瓣膜置换手术患者不同时相的血、尿标本，分别测定血、尿NGAL和血肌酐（Scr）。依Scr水平分为AKI组和非AKI组，利用受试者工作特征（ROC）曲线评价血、尿NGAL对AKI的早期诊断价值。结果56例患者中有16例发生AKI，AKI组中Scr升高峰值出现在术后12～24h内，术后2h血NGAL开始显著升高（P〈0．05），4h时达峰值，术后2h尿NGAL开始升高，并达到峰值；术后4h血NGAL及术后2h尿NGAL诊断AKI的ROC曲线下面积分别为0．891，0．934，分别以50pg／L及110斗∥L作为AKI的诊断界限时均表现出较高的敏感性及特异性。结论心脏瓣膜置换术后，血、尿NGAL可作为AKI发生的早期诊断标志物，其水平变化的时间早于Scr的变化。

Objective To explore the value of neutiophil gelatinase-associated lipocalin （NGAL） taken from blood and urine samples in early diagnosis of acute kidney injury （AKI） after heart valves replacement surgeries. Meth- ods A total of 56 patients received heart valves replacement surgeries were selected prospectively in this study. NGAL from blood and urine samples and serum creatinine （Scr） were tested among them at different moments. AKI and non-AKI groups were divided based on Scr levels and the value of NGAL taken from blood and urine sam- ples was estimated in early diagnosis of AKI with receiver operating characteristic curve （ROC）. Results 16 AKIs were observed among all of them. The Peak value of Scr in AKI group was shown between 12 and 24 hours after surgeries, while blood-NGAL was seen high significantly （P 〈 0.05 ） since 2 hours after surgeries, peak value at 4 hours, for urine-NGAL, peak value was seen at 2 hours. The area of ROC of blood-NGAL 4 hours and urine-NGAL 2 hours after surgeries for AKI diagnosis were 0. 891 and 0. 934, respectively. The better sensitivity and specificity were shown in both threshold set as 50 ixg/L and 110 μg/L. Conclusion Blood-NGAL and urine-NGAL can be used as early diagnostic markers of AKI after heart valves replacement surgeries, whose change is significantly earli- er than that of Scr.