尿中性粒细胞明胶酶相关脂质运载蛋白对脑动脉支架置入术后造影剂肾病严重程度的预测价值

Value of urinary neutrophil gelatinase-associated lipocalin in predicting contrast-induced nephropathy after cerebral artery stenting

目的 评价老年患者尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对脑动脉支架置入术后致造影剂肾病（CIN）的早期诊断价值及其严重程度的预测价值.方法 选择CIN患者15例（CIN组）,其中CIN Ⅰ期12例,CINⅡ期3例;非CIN患者15例（对照组）,连续收集尿标本进行NGAL分析.结果 与对照组比较,CIN组及CIN Ⅰ期、CINⅡ期患者术后3、6、12、24 h和CINⅡ期患者术后48 h尿NGAL明显增高,CIN组及CIN Ⅰ期、CINⅡ期患者尿NGAL术后0～3 h、0～6 h、0～12 h、0～24 h、0～48 h绝对变化值明显增高（P＜0.05）.与CIN Ⅰ期比较,CINⅡ期患者尿NGAL术后0～6 h、0～12 h绝对变化值明显增高（P＜0.05）.CIN组术后0～6h尿NGAL绝对变化值与术后48 h估算肾小球滤过率呈负相关（r=-0.480,P=0.001）.结论 动态监测尿NGAL既可早期诊断CIN,也可对CIN严重程度有一定的预测作用.

Objective To assess the value of urinary neutrophil gelatinase-associated lipocalin （NGAL） in early diagnosis of contrast-induced nephropathy （CIN） in elderly patients after cerebral artery stenting.Methods Fifteen CIN patients （stage Ⅰ 12,stage Ⅱ 3） served as a CIN group and 15 non-CIN patients served as a control group in this study.Their urinary NGAL levels were measured.Results The urinary NGAL levels were significantly higher in CIN group than in control group at 3,6,12,24 h after stenting and in CIN patients at stage Ⅱ than in control group at 48 h after stenting.The absolute urinary NGAL value was significantly higher in CIN group than in control group at 0-3,0-6,0-12,0-24,0-48 h and in CIN patients at stage Ⅱ than in those at stage Ⅰ at 0-6 and 0-12 h after stenting （P〈0.05）.The absolute urinary NGAL value in CIN group at 0-6 h was negatively related with the eGFR at 48 h after stenting （r=-0.480,P=0.001）.Conclusion Dynamic urinary NGAL monitoring can not only contribute to the early diagnosis of CIN but also predict its severity in elderly patients after cerebral artery stenting.