NGAL在择期冠状动脉介入术后早期肾损害中临床应用价值的初步探讨

The clinical significance of neutrophil gelatinase-associated lipocalin in early kidney injury after elective percutaneous coronary intervention

目的 探讨免疫透射比浊法测定的中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在择期冠状动脉介入治疗术后早期肾损害中的临床应用价值.方法 临床病例对照研究.收集2013年4至8月于泰达国际心血管病医院接受冠状动脉介入术治疗的稳定性心绞痛及急性冠状动脉综合征患者201例.用酶法测定所有入选患者术前及术后2、4、8、24、48 h血肌酐值;用免疫透射比浊法测定所有入选患者术前及术后2、4、8、24h血NGAL值及术前、术后8和24h尿NGAL值.将发生对比剂肾病（CIN）的患者纳入病例组,在入选患者中按1∶4比例选取未发生对比剂肾病的患者纳入对照组,两组正态分布的定量资料采用t检验,非正态分布的定量资料采用非参数秩和检验进行比较.结果 201例患者中发生CIN的患者8例,发病率为3.98％.ROC曲线分析发现,各时段血NGAL中术后2h、8h血NGAL曲线下面积（AUC）均大于0.9,术后2h血NGAL的AUC为0.928,95％可信区间（CI）0.800 ～0.985,以109 ng/ml为诊断截点时,其在CIN诊断中的敏感度和特异度分别为87.5％和100％;术后8h血NGAL的AUC为0.945,95％ CI0.824～0.992,以96 ng/ml为诊断截点时,其在CIN诊断中的敏感度和特异度分别为87.5％和87.5％.各时段尿NGAL中术后8h尿NGAL的AUC最大为0.969,95％ CI0.859 ～0.999,以91 ng/ml为诊断截点时,其在CIN诊断中的敏感度和特异度分别为87.5％和100％.结论 血、尿NGAL对CIN的早期诊断价值早于血肌酐,可作为择期冠状动脉介入术后早期肾损害的预测指标.

Objective To explore the clinical application value of neutrophil gelatinase-associated lipocalin（ NGAL）which were tested by immunity transmission turbidity in early kidney injury after elective percutaneous coronary intervention. Methods A case-control study was conducted. All 201 stable angina pectoris and acute coronary syndrome patients undergone percutaneous coronary intervention in TEDA International Cardiovascular Hospital, during April to August 2013, were enrolled in this study. Before and 2 h,4 h,8 h,24 h,48 h after the operation, the plasma creatinine of the patient samples were tested by enzymic method. Before and 2 h, 4 h, 8 h, 24 h after the operation, the plasma NGAL was tested by immunity transmission turbidity method. Before and 8 h, 24 h after the operation, the urinary NGAL was tested by immunoturdimetric method. The data were compared between contrast induced nephrpathy （CIN） and non-CIN groups. For normal distribution of quantitative data, t test were used and for non-normal distribution of quantitative data, nonparametric rank and inspection were used. Results CIN occurred in 8 of 201 enrolled patients, the incidence was 3.98%. Receiver operating characteristic curve （ROC） analysis confirmed the diagnostic accuracy of the plasma NGAL in CIN, and the area under the curve（AUC） of 2 h plasma NGAL was 0. 928,95% CI 0. 800 -0. 985 ,with the cut-off value NGAL as 109 ng/ml, the diagnosticsensitivity and specificity for CIN were 87.5% and 100% ;the AUC of 8 h plasma NGAL was 0. 945,95% CI 0. 824 -0. 992,with the cut-off value NGAL as 96 ng/ml, the diagnostic sensitivity and specificity for CIN were 87.5% and 87.5% ;the AUC of 8 h urinary NGAL was 0. 969, 95% CI 0. 859 - 0. 999 , with the cut- off value NGAL as 91 ng/ml, the diagnostic sensitivity and specificity for CIN were 87.5% and 100%. Conclusions The change of plasma and urinary NGAL is earlier to that of serum creatinine for the early diagnosis of CIN. It can be used as the predictor of early renal damage after elective coronary artery interventional.