肾损伤分子-1、中性粒细胞明胶酶相关脂质运载蛋白在早期诊断高强度军训致肾损伤的临床研究

Clinical research of kidney injury molecule-l, neutrophilgelatinase associated lipocalcin early detecting the kidney injury caused by high intensive military training

目的研究某部特勤人员高强度军训5km武装越野跑后肾损伤分子-1（kidney injury molecule-1，KIM-1）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophilgelatinase associated lipocalcin，NGAL）变化特征，探讨其作为早期肾损伤诊断标志物的可能性。方法观察某部海训人员，行5km武装越野跑，观察训练前后不同时间的尿液uKIM-1、uNGAL、尿微量白蛋白、NAG含量。其中随机100人抽静脉血检查sKIM-1、sNGAL。结果5km武装越野跑结束后即刻，uKIM-1、uNGAL浓度分别较基线升高70．55％、92．85％，6h后分别升高104．21％、142．79％。训练后即刻KIM-1、NGAL血清与尿液浓度显著正相关，P〈0．05，各时间段uKIM-1、uNGAL的ROC曲线下面积大于白蛋白、NAG。uKIM-1、uNGAL的ROC曲线下面积大于sKIM-1、sNGAL。结论5km武装越野跑后尿KIM—1、NGAL在训练后即刻开始升高，6h为峰值，诊断肾损伤效能优于尿白蛋白、NAG。uKIM-1、uNGAL可以早期、便捷、敏感地反映高强度军训肾损伤。

Objective To approach the characters of the serum and urine KIM-1, NGAL after 5 km armed military training in a special forces, and discuss whether the biomarkers is able to early detect the kidney injury caused by high intensive military training. Methods The urine markers such as uKIM-1, uNGAL, albumin, NAG before and 20 minutes, 6 hours, 24 hours after 5 km armed military training were observed. Venous blood samples were collected to test sKIM-l, sNBAL from 100 soldiers who were randomly selected. Results The uKIM-1, uNGAL were increased immediately after the training, compared with the baselines. The urine concentrations of the uKIM-1, uNGAL increased 70.55%, 92.85% at the point of 20 minutes, 104.21%, 142.79% at the point of 6 hours respectively. The uKIM-1 was significantly positively correlated with the sKIM-1 immediately after training （P 〈0.05, r=0.62）, and the uNGAL was moderately correlated with the sNGAL （P 〈0.05, r=0.53）. Receiver operating characteristic （ROC） analysis showed the area under the curve （AUC） of the uKIM-1, uNGAL were more than those of albumin, NAG, sKIM-I, sNGAL in any time after training. Conclusion After 5 km armed military traning, the uNGAL, uKIM-1 increased immediately. They reach the peak values at the point of 6 hours, and the diagnosis efficiencies were better than those of urine protein, albumin, NAG. The uKIM-1, uNGAL are considered being early, convenient, sensitive, reliable biomarkers to diagnose the kidney injury caused by high intensive military training.