DR患者血清中性粒细胞明胶酶相关脂质运载蛋白含量测定的临床意义

The impact of Neutrophil gelatinase associated lipocalin level with diabetic retinopathy patient

目的通过检测糖尿病视网膜病变(diabetic retinopathy,DR)患者的中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)及相关危险因素的变化,了解该指标的临床价值。方法连续性、回顾性收集我院于2013年1月1日至2014年1月1日收治入院DR患者的临床资料,另纳入同期入院的糖尿病病程近10 a的非DR患者为对照组,获取平均动脉压、体质量指数、空腹C肽(fasting C peptide,FCP)、空腹血糖、糖化血红蛋白(hemoglobin Alc,Hb Alc)、血肌酐、甘油三酯、总胆固醇、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、微小RNA-21、细胞角蛋白多肽^(-1)9(cytokeratin19,Ck^(-1)9)、凝血酶原时间、24 h尿蛋白定量及NGAL含量。所有DR患者均常规随访1 a以上以记录是否进展至PDR阶段。依据随访结果,将DR患者分为NPDR组及PDR组,对比两组患者组间资料的差异性。结果经过纳入、排除及剔除标准,共搜集61例患者的临床资料,其中55例患者完成随访,至随访末期PDR 20例,NPDR 35例。另纳入对照组72例,三组患者年龄、患高血压病者比例、吸烟者比例、LDL-C、Hb Alc、FCP、CK^(-1)9、NGAL差异均有统计学意义(均为P<0.05);将PDR组患者的NGAL与其他具有差异性的实验室检查指标进行PPMCC检验以验证其相关性:NGAL与Hb Alc呈正相关(r=0.570,P<0.05)、与FCP呈正相关(r=0.529,P<0.05)、与CK^(-1)9呈正相关(r=0.582,P<0.05);多因素Logistic回归模型提示:较高水平的LDL-C、Hb Alc、FCP、NGAL是初检DR患者1 a内进展至PDR阶段的独立危险因素(均为P<0.05);绘制NGAL作为独立危险因素评判DR患者不良预后的ROC曲线,曲线下面积为0.807、95%CI(0.768~0.850)。NGAL最佳预测值为76.82 ng·m L^(-1),其灵敏度为71.69%、特异度为82.64%。绘制相关KM生存曲线,亦可证实NGAL高于76.82 ng·m L^(-1)的DR患者具有更高的不良预后风险(85.71%vs 8.82%,χ2=7.976,P<0.05)。结论血清NGAL对于DR患者的诊断、识别高危风险、评估预后等方面具有重要意义。

Objective To understand the clinical value of some indicator by detecting the changes of neutrophil gelatinase associated lipocalin（NGAL） and related risk factors in diabetic retinopathy（DR） patients.Methods The clinical data of DR patients from January 1,2013 to January 1,2014 in our hospital were retrospectively collected,and another diabetic patients without DR were chosen as the control group.Mean arterial pressure（MAP）,body mass index,fasting C peptide（FCP）,hemoglobin Alc（HbAlc）,serum creatinine,triglyceride,total cholesterol,low density lipoprotein-cholesterol（LDL-C）,microRNA-21,cytokeratin 19（Ck-19）,prothrombin time,quantitative test of 24 hours urinary protein（QT24UP） and NGAL were detected.All DR patients were routinely followed up for 1 year with whether to record progress to PDR stage.Based on follow-up results,the patients were divided into NPDR group and PDR group.The data between two groups of patients were compared.Results Based on inclusion,exclusion and exclusion criteria,the clinical data of 61 patients were collected,in which 55 patients completed the follow up,20 cases in PDR group,35 cases in NPDR group.Also 72 cases were included in the control group.There was no statistical difference in age,hypertension,smoking,LDL-C,HbA1 c,FCP,CK-19,NGAL among three groups（all P〉0.05）.The relationship NGAL with other laboratory parameters in PDR group were tested by PPMCC：NGAL were positively correlated with HbAlc（r = 0.570,P〈0.05）,NGAL was positively correlated with FCP（r = 0.529,P〈0.05）,NGAL was positively correlated with CK-19（r = 0.582,P〈0.05）;Multivariate Logistic regression model suggested that high levels of LDL-C,HbAlc,FCP and NGAL were the independent risk factors for DR patients progressed into PDR within 1 year（all P〈0.05）.ROC curve was drawn to show the N GAL as an independent risk factor for evaluation DR patients with poor prognosis,the area under the curve was 0.807,95%confidence interval ranged between 0.768 and 0.850.The best predictive value of NGAL was76.82 ng·mL^-1,the sensitivity was 71.69%,the specificity was 82.64%.KM survival curve was drawn,and also confirmed that the patients with NGAL higher than 76.82 ng·mL^-1 had a higher risk of poor prognosis（85.71%vs 8.82%,χ^2=7.976,P〈0.05）.Conclusion The serum NGAL plays an important role in diagnosis of D R,identifying the high risk and assessing prognosis.