尿Kim-1、NGAL和NAG联合检测对慢性丙型肝炎早期肾损伤的诊断价值

Diagnostic value of urinary Kim-1,NGAL and NAG combined detection in early renal injury of chronic hepatitis C

目的研究肾小球滤过功能与尿肾损伤分子-1(Kim-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和N-乙酰β-葡萄糖苷酶(NAG)的关系及其联合检测对慢性丙型肝炎患者早期肾损害的诊断价值。方法选取78名慢性丙肝患者组成观察组,选取参加健康检查的健康人80名组成对照组,2组研究对象分别采集血液和尿液标本,测定血常规、尿常规、肝功能和肾功能指标,测定尿Kim-1、NGAL、NAG,同时进行肾小球滤过率(GFR)测定,分析尿Kim-1、NGAL、NAG与肾小球滤过功能指标的关系,进一步使用受试者工作曲线(ROC)探究尿Kim-1、NGAL、NAG在慢性丙型肝炎早期肾损伤中的测定意义。结果在性别、年龄和丙氨酸转氨酶(ALT)上观察组与对照组差异无统计学意义(P>0.05)。观察组白细胞计数(WBC)、血小板计数(PLT)、天冬氨酸转氨酶(AST)、球蛋白(GLB)、总胆红素(TBA)比对照组明显升高,白蛋白(ALB)比对照组明显减低,差异有统计学意义(P<0.05)。观察组尿Kim-1为(78.38±6.97)ng/L、NGAL为(6.14±0.39)μg/L、NAG为(31.37±5.11)U/L,比对照组显著增高,差异有统计学意义(P<0.05)。观察组GFR为(71.27±8.12)ml/min显著低于对照组,且肌酐(Cr)为(178.32±12.34)μmol/L、尿素氮(BUN)为(19.21±1.28)nmol/L、β2微球蛋白(β2-MG)为(5.81±0.31)mg/L,比对照组均显著增高,差异有统计学意义(P<0.05)。观察组尿Kim-1、NGAL、NAG含量与GFR呈负相关性,与Cr、BUN、β2-MG呈正相关性(P<0.05)。尿Kim-1、NGAL、NAG联合测定的阳性率(84.6%)比单一项目的阳性率明显升高,差异有统计学意义(P<0.05)。结论慢性丙型肝炎患者可引起肾损伤,检查尿Kim-1、NGAL、NAG可提高慢性丙型肝炎患者早期肾损伤诊断的敏感性,且与肾小球滤过率相关,其联合检测可以提高诊断慢性丙型肝炎患者肾功能早期病变的阳性率,对慢性丙型肝炎患者肾功能早期病变的诊断有一定的意义。

[Objective]To investigate the relationship between the glomerular filtration function and urinary kidney injury molecule-1 (Kim-1),neutrophil gelatinase-associated lipocalin (NGAL)and N-Acetyl-β-D-Glucosaminidase (NAG),explore the diagnostic value of of their combined detection in the early renal damage in patients with chronic hepatitis C.[Methods]78 patients with chronic hepatitis C were recruited in the observation group,while 80 healthy subjects in health examination were enrolled in the control group. The samples of blood and urine were collected from both two groups,to measure blood routine,urine routine,liver function and renal function indexes,test urinary Kim-1,NGAL and NAG,detect the glomerular filtration rate(GFR) at the same time, and analyze the relationship of urinary Kim-1,NGAL,NAG and glomerular filtration function indexes. Moreover,Operating Characteristic (ROC) was used to explore the value of urinary Kim-1,NGAL and NAG in early renal injury in chronic hepatitis C. [Results]There were no statistically significant differences in gender,age and ALT between the observation group and the control group(P>0.05). The levels of white blood cell(WBC)count ,platelet(PLT) count ,aspartate aminotransferase (AST),globulin (GLB) and total bilirubin(TBA) in the observation group were higher than those in the control group,while the level of albumin(ALB) in the observation group was lower than that in the control group ,and the differences were statistically significant (P <0.05 ). In the observation group,urinary Kim-1 level was(78.38±6.97)ng/L,NGAL level was(6.14±0.39)μg/L,NAG level was (31.37±5.11) U/L,which were higher than those in the control group,and the differences were statistically significant (P<0.05). The GFR level in the observation group was (71.27±8.12)ml/min,which was lower than that in the control group,the Cr level was(178.32±12.34)μmol/L, BUN level was (19.21±1.28)nmol/L,β2-MG level was (5.81±0.31)mg/L,which were higher than those in the control group,and the differences were statistically significant(P<0.05). The contents of urinary Kim-1,NGAL and NAG in the observation group were negatively correlated with GFR,and positively correlated with Cr,BUN and β2-MG(P<0.05). The positive rate of combined detection for urinary Kim-1,NGAL and NAG was 84.6% ,which was higher than the positive rate of single index,and the difference was statistically significant(P<0.05).[Conclusion]The chronic hepatitis C can cause kidney damage in patients. The detection of urinary Kim-1,NGAL and NAG can improve diagnosis sensitivity of early renal injury in patients with chronic hepatitis C. And it associated with glomerular filtration rate,the joint detection can improve the positive rate of early renal damage in patients with chronic hepatitis C,which has certain significance for the diagnosis of early renal damage in patients with chronic hepatitis C.