中性粒细胞明胶酶脂质运载蛋白在体外循环术后早期诊断急性肾损伤中的应用

APPLICATION OF NGAL IN EARLY DIAGNOSIS OF ACUTE KIDNEY INJURY AFTER CARDIOPULMONARY BYPASS

目的 探讨中性粒细胞明胶酶脂质运载蛋白（Neutrophil Gelatinase-Associated Lipocalin,NGAL）在体外循环术后患者早期诊断急性肾损伤（Acute Kidney Injury,AKI）中的应用价值。方法 选择90例进行体外循环手术的心脏病患者,术前及体外循环术后12、24、48 h采集尿样及血样,检测尿NGAL、血半胱氨酸蛋白酶抑制剂C（cystatin C,Cys-C）、血肌酐（Serum Creatinine,Scr）含量;根据AKI诊断标准,将90例患者分为AKI组和非AKI组,并对两组尿NGAL、血Cys-C、血Scr检验结果进行分析;运用受试者工作特征曲线（ROC）分析术后12 h的尿NGAL的检测效能,并确定尿NGAL检测AKI的临界值。结果 90例患者中术后48 h内发生不同程度AKI有21例,发生率为23.3%;两组尿NGAL、血Cys-C、Scr基线值比较：术前差异无统计学意义（P〉0.05）,术后差异有统计学意义（P〈0.05）;AKI组在体外循环术后：12 h尿NGAL浓度显著升高,24 h血Cys-C显著升高,Scr水平48 h显著升高;术后12 h尿NGAL检测AKI的曲线下面积（AUC）为0.949（95%CI：0.882~0.984）,检测AKI的最佳临界值（Cut-off）为38.9μg/L,此时其检测AKI的灵敏度为90.48%,特异度为97.10%。结论 尿NGAL可以作为体外循环术后AKI的预测指标,在诊断AKI时较血Cys-C、血Scr早,有利于早期对AKI进行预防和干预。

Objective To explore the application of neutrophil gelatinase - associated lipocalin （NGAL） in patients with acute kidney injury （AKI） after cardiopulmonary bypass. Methods Cardiopulmonary bypass was performed to 90 patients with heart disease. Urine and blood samples were collected before and after surgery （ at 12, 24, 48 h after surgery respectively）. The contents of urinary NGAL, serum cystatin C （ Cys - C） and serum creatinine （Scr） were detected. According to the diagnostic criteria for AKI, 90 patients were divided into AKI group and non - AKI group. The concentrations of urinary NGAL, serum Cys - C and Scr in the two groups were analyzed. Receiver operation curve （ROC） was used to analyze the detection of urinary NGAL at 12h after surgery and determine the crit- ical value. Results 21 of the 90cases （23.3%） developed AKI within 48h after surgery. There were statistically insignificant differences between the two groups in terms of the baselines of urinary NGAL, serum Cys - C and Scr before surgery （ P 〉 0. 05 ）, but there were significant differences after surgery （ P 〈 0.05 ）. In AKI group, the levels of urinary NGAL, serum Cys - C and Scr significantly increased at 12 h, 24 h, and 48 h after surgery, respectively. The area under the ROC of urinary NGAL at 12h after surgery was 0.949 （95% CI： 0. 882 -0. 984）. The optimal cutoff value was 38.9 μg/L leading to a sensitivity of 90.48% and specificity 97.10% in detection of AKI. Conclu- sion The urinary NGAL is more sensitive than Cys - C and Scr in diagnosis of AKI, and it can serve as a prediction index helpful to prevent AKI after cardiopulmonary bypass.