血清CysC及尿NGAL在百草枯中毒患者急性早期肾损伤中诊断价值

Diagnostic Value of Serum CysC and Urinary NGAL of Acute Kidney Injury in Patients with Paraquat Poisoning

目的:探讨血清半胱氨酸蛋白酶抑制剂C(CysC)及尿性粒细胞明胶酶相关脂质运载蛋白(NGAL)在百草枯中毒患者急性早期肾损伤(AKI)中的诊断价值。方法:选择2011年3月至2015年3月我院收治的300例百草枯中毒患者为病例组,另选取来我院150例健康体检者为对照组,病例组根据是否发生AKI分为AKI组与非AKI组,各150例,采用酶联免疫吸附法检测NGAL、肌氨酸氧化酶法检测血清肌酐(Scr)水平、免疫透射比浊法检测CysC水平,观察所有对象入院后15 min、2 h、4 h、8 h、12 h、24 h、48 h、3 d、5 d、7 d CysC、NGAL以及Scr表达水平的变化。结果:AKI组和非AKI组患者入院后8 h、12 h、24 h、48 h、3 d、5 d、7 d的Scr水平均高于对照组,差异具有统计学意义(P<0.05);AKI组患者入院后12 h、24 h、48 h、3 d、5 d、7 d Scr水平明显高于非AKI组,差异具有统计学意义(P<0.05);AKI组入院后2 h、4 h、8 h、12 h、24 h、48 h、3 d、5 d、7 d,非AKI组入院后8 h、12 h、24 h、48 h、3 d、5 d、7 d的NGAL水平明显高于对照组,差异均有统计学意义(P<0.05);AKI组患者NGAL水平在入院后48 h升至峰值,而后开始缓慢下降,且AKI组入院后4 h的NGAL水平便开始明显高于非AKI组(P<0.05);AKI组基本在入院后8 h、非AKI组在入院后12 h的CysC水平便明显高于对照组(P<0.05),AKI组基本在入院后3d升至峰值,而后开始缓慢下降,且AKI组在入院后12 h的CysC水平便开始明显高于非AKI组,差异具有统计学意义(P<0.05)。结论:血清CysC及尿NGAL水平在百草枯中毒后短时间内会出现异常升高,对早期诊断AKI具有积极意义。

Objective： To investigate the diagnostic value of serum Cystatin C（CysC）and urinary neutrophil gelatinase associated lipocalin（NGAL）of acute kidney injury（AKI）in patients with paraquat poisoning. Methods： Selected 300 cases of patients with paraquat poisoning who treated in our hospital from March 2011 to March 2015 as the case group, and 150 cases of healthy physical examination subjects as the control group, case group was divided into AKI group and non AKI group according to whether occurrence of AKI,with150 patients in each group, detected the NGAL by enzyme linked immunosorbent assay, and detected the serum creatinine（Scr） level by Muscle ammonia oxidase method, and detected CysC level by immune transmission turbidity method, observed the change of expression level of CysC, NGAL in all objects at 15 min, 2 h, 4 h, 8 h, 12 h, 24 h, 48 h, 3 d, 5 d, 7 d after admission. Results： The Scr levels of AKI group and non AKI group were significantly higher than control group at 8 h, 12 h, 24 h, 48 h, 3 d, 5 d, 7 d after admission, the differences were statistically significant（P〈0.05）; The Scr levels of AKI group were significantly higher than non AKI group at 12 h, 24 h,48 h, 3 d, 5 d, 7d after admission, the differences were statistically significant（P〈0.05）; The NGAL levels of AKI group at 2 h, 4 h, 8 h,12 h, 24 h, 48 h, 3 d, 5 d, 7 d after admission, and non AKI group at 8 h, 12 h, 24 h, 48 h, 3 d, 5 d, 7 d after admission were significantly higher than control group, the differences were statistically significant（P〈0.05）; The NGAL level in AKI group at 48 h after admission to the peak, then decreased slowly, and the NGAL level of AKI group was began significantly higher than non AKI group at 4h after admission, the differences were statistically significant（P〈0.05）; The CysC levels of AKI group at 8 h after admission, and non AKI group at 12 h after admission were began significantly higher than control group,the differences were statistically significant（P〈0.05）, the CysC level of AKI group rose to the peak at 3 d after admission, and then began to slow down, and the CysC level in AKI group was began significantly higher than that in non AKI group at 12 h after admission, the differences were statistically significant（P〈0.05）. Conclusion：The serum CysC and urinary NGAL levels in a short period after the paraquat poisoning will be unusually high, which has a positive significance for the early diagnosis of AKI.