血、尿中性粒细胞明胶酶相关脂质运载蛋白对肝硬化急性肾损伤的诊断价值

Clinical significance of plasma and urine neutrophil gelatinase-associated lipocalin levels in diagnosis of acute kindney injury in patients with cirrhosis

目的研究血液、尿液中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对肝硬化患者急性肾损伤的诊断价值。方法选择2012年1月-2014年12月于第二军医大学附属长征医院南京分院就诊的肝硬化患者78例,分为肝硬化并发急性肾损伤的患者38例,肝硬化未并发急性肾损伤的患者40例,并以健康体检者40例为对照。采用ELISA法检测血清和尿液中的NGAL浓度,并将血肌酐(Scr)浓度和肾小球滤过率(GFR)进行组间比较。多组间差异比较采用单因素方差分析,进一步两两比较采用SNK-q检验;相关分析采用简单直线相关分析法。结果肝硬化并发急性肾损伤组的血清NGAL、尿液NGAL同肝硬化未并发急性肾损伤组和健康对照组相比,差异均有统计学意义(P值均<0.01);将肝硬化并发急性肾损伤患者依照肾损伤标准进行分期,分期高者血清、尿液中的NGAL浓度显著高于分期低的患者,差异均有统计学意义(P值均<0.01);肝硬化并发急性肾损伤患者血、尿NGAL浓度与GRF呈负相关(r值分别为-0.757,-0.547,P值均<0.05)。结论 NGAL可以作为肝硬化急性肾损伤患者的诊断指标,对了解肝硬化患者的肾功能损伤状况,及早制订相应措施,具有重要意义。

Objective To explore the significance of plasma neutrophil gelatinase - associated lipocalin （pNGAL） and urine neutrophil ge- latinase - associated lipocalin （uNGAL） in the diagnosis of acute kidney injury （AKI） in patients with cirrhosis. Methods A total of 78 patients with cirrhosis admitted to our hospital from January 2012 to December 2014 were selected and divided into group A of 38 patients with cirrhosis and AKI and group B of 40 patients with cirrhosis alone. The control group （ group C） iucluded 40 healthy people uudergoing the routine physical examination. The NGAL concentrations in serum and urine were measured by enzyme - linked immunosorbent assay. The levels of pNGAL, uNGAL, and serum creatinine, as well as glomerular filtration rate （ GFR）, were compared between different groups. The comparison between different groups was made by one - way ANOVA and simple linear correlation analysis was used to investigate the re- lationship of GFR with pNGAL and uNGAL in group A. Results The NGAL levels in serum and urine in group A were significantly higher than those in groups B and C （ all P 〈 0.01 ）. Staging of AKI was made according to the kidney injury criteria and the NGAL levels in serum and urine significantly increased with AKI stage （ all P 〈0.01 ）. In group A, NGAL level was negatively correlated with GFR in both serum （ r = - 0. 757, P 〈 0.05 ） and urine （r = - 0. 547, P 〈 0.05 ）. Conclusion NGAL can be used as an indicator in the diagnosis of AKI in patients with cirrhosis. Early and continuous measurement of serum and urine NGAL levels in patients with cirrhosis and AKI has a great significance in monitoring the progression of renal damage in the patients and developing timely and appropriate intervention measures.