尿中性粒细胞明胶酶相关脂质运载蛋白水平在脓毒症急性肾损伤早期诊断中的临床意义

Clinical significance of early diagnostic value of urinary neutrophil gelatinase-associated lipocalin in acute kidney injury in sepsis patients

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平对脓毒症急性肾损伤（AKI）早期诊断的价值.方法 选择2014年6月至2015年12月上海中医药大学附属曙光医院宝山分院重症加强治疗病房（ICU）入住的126例脓毒症患者,按是否合并AKI为两组.比较两组脓毒症确诊即刻和确诊后12、24、48 h尿NGAL水平;绘制受试者工作特征曲线（ROC曲线）,评价尿NGAL水平对早期诊断脓毒症AKI的价值.结果 合并AKI组（60例）,随确诊时间延长,尿NGAL（μg/L）水平逐渐升高,确诊后12、24、48 h均较相应时间点未合并AKI组（66例）明显升高（12 h：178.2±32.8比53.8±10.4,24 h：228.4±24.6比54.1±9.0,48 h：186.1±43.6比52.5±9.4,均P〈0.05）.确诊即刻和确诊后24 h尿NGAL的ROC曲线下面积（AUC）和95%可信区间（95%CI）分别为0.863（0.766~0.929）和0.686（0.466~0.696）;确诊即刻尿NGAL的截断值为65.9μg/L,敏感度和特异度分别为81.9%、76.1%;确诊后24 h截断值为57.9μg/L,敏感度和特异度分别为70.2%、57.2%.结论 尿NGAL可作为早期诊断脓毒症AKI的参考指标.

Objective To estimate the value of urinary neutrophil gelatinase-associated lipocalin （NGAL） level for early diagnosis of acute kidney injury （AKI） in patients with sepsis.Methods One hundred and twenty-six sepsis patients admitted to intensive care unit （ICU） in Baoshan Branch Hospital of Shuguang Hospital Affiliated to Shanghai University ofTraditional Chinese Medicine from June 2014 to December 2015 were enrolled, and they were divided into two groups according to whether complication of AKI was present. The levels of urinary NGAL in the two groups of septic patients were evaluated immediately and at 12, 24 and 48 hours after the definite diagnosis, and the levels were compared between the two groups; the receiver operating characteristic curve （ROC curve） was performed and the value of urinary NGAL level in early diagnosis of sepsis AKI was evaluated.Results There were 60 septic cases complicated with AKI （AKI group）, with the prolongation of time after definite diagnosis, the urinary NGAL （g/L） levels were gradually increased at 12, 24 and 48 hours, the levels were significantly higher than those at the corresponding time points in the group without AKI [non AKI group （66 cases）, 12 hours： 178.2±32.8 vs. 53.8±10.4, 24 hours： 228.4±24.6 vs. 54.1±9.0, 48 hours： 186.1±43.6 vs. 52.5±9.4, allP 〈 0.05]. The area under ROC curve （AUC） of urinary NGAL level at 24 hours after definite diagnosis and 95% confidence interval （CI） were 0.863 （0.766-0.929） and 0.686 （0.466-0.696）, respectively, when the cutoff value of urinary NGAL was 65.9μg/L, the sensitivity was 81.9% and specificity 76.1%; when the cutoff value of urinary NGAL was 57.9μg/L, the sensitivity was 70.2% and the specificity 57.2%.Conclusion Urinary NGAL level can be used as a reference marker for the early diagnosis of sepsis concomitant AKI.