老年冠心病慢性心力衰竭患者血清中性粒细胞明胶酶相关脂质运载蛋白水平变化及意义

Changes and clinical significance of serum neutrophil gelatinase-associated lipocalin in elderly chronic heart failure patients with coronary heart disease

目的探讨老年冠心病慢性心力衰竭（chronic heart failure,CHF）患者血清中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase associated lipocalin,NGAL）水平变化及其临床意义。方法 84例老年冠心病CHF患者依据NYHA心功能分级分为Ⅰ级组30例,Ⅱ级组28例,Ⅲ~Ⅳ级组26例,检测各组血清NGAL及血肌酐（serum creatinine,SCr）、血尿素氮（blood urea nitrogen,BUN）、三酰甘油（triacylglycerol,TG）、总胆固醇（total cholesterol,TC）、血白蛋白（albumin,Alb）、尿微量白蛋白（urinary microalbumin,UmAlb）、血清N末端B型利钠肽原（N-terminalpro-B-type natriuretic peptide,NT-proBNP）水平,测量患者左心室舒张末期内径（left ventricular end-diastolic dimension,LVEDD）、左室射血分数（left ventricular ejection fraction,LVEF）,并分析血清NGAL水平与各指标的相关性;随访6个月观察患者死亡和再入院情况。结果血清NGAL水平随心功能分级增加而升高,3组血清NGAL水平两两比较差异均有统计学意义（P〈0.05或P〈0.01）;血清NGAL水平与NYHA心功能分级、LVEDD、NT-proBNP、SCr、BUN及UmAlb呈正相关（r=0.467,P=0.000;r=0.564,P=0.000;r=0.796,P=0.000;r=0.598,P=0.000;r=0.526,P=0.000;r=0.560,P=0.000）;与LVEF及估计肾小球滤过率呈负相关（r=-0.348,P=0.001;r=-0.591,P=0.000）;6个月内死亡患者和再入院患者血清NGAL和NT-proBNP水平均高于存活和未再入院患者（P〈0.01）。结论老年冠心病CHF患者血清NGAL水平与心、肾功能具有相关性,可作为诊断早期肾损害和评估预后的指标。

Objective To explore the changes of serum neutrophil gelatinase-associated lipocalin（NGAL）level and its clinical significance in chronic heart failure（CHF）patients with coronary heart disease.Methods Eighty-four elderly CHF patients with coronary heart disease were divided into 3groups according to NYHA cardiac function classification：classⅠgroup（n=30）,classⅡgroup（n=28）and classⅢ-Ⅳgroup（n=26）.Serum NGAL,serum creatinine（SCr）,blood urea nitrogen（BUN）,triacylglycerol,total cholesterol,albumin,urinary microalbumin（UmAlb）and N-terminalpro-B-type natriuretic peptide（NT-proBNP）were detected in three groups.The left ventricular end-diastolic dimension（LVEDD）and left ventricular ejection fraction（LVEF）were measured.The relationship of serum NGAL with the above indicators was analyzed.Readmission and death in 6months were recorded.Results Serum NGAL level increased along with the increase of NYHA cardiac function classification.Significant statistics difference was found in multiple comparison in serum NGAL level among three groups（P〈0.05 or P〈0.01）.Serum NGAL level was positively correlated with NYHA classification,LVEDD,NT-proBNP,SCr,BUN and UmAlb（r=0.467,P=0.000;r=0.564,P=0.000;r=0.796,P=0.000;r=0.598,P=0.000;r=0.526,P=0.000;r=0.560,P=0.000）,and was negatively correlated with LVEF and estimated glomerular filtration（r=-0.348,P=0.001;r=-0.591,P=0.000）.Serum NGAL and NT-proBNP were higher in the readmitted or died patients in 6months than those in the patients with no readmission or death（P〈0.01）.Conclusion Serum NGAL is correlated with cardiac and renal function in the elderly CHF patients with coronary heart disease.It can be used as a marker for the diagnosis of early renal damage.