肝硬化患者继发急性肾损伤的实验室评价

Evaluation of renal function parameters in acute kidney injury patients secondary to liver cirrhosis

目的探讨中性粒细胞相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(CysC)和肌酐(Cr)检测在肝硬化患者继发急性肾损伤(AKI)中的应用价值。方法选取2015年1月至2016年8月绵阳市中心医院符合入选标准的肝硬化继发AKI患者207例(AKI组)、单纯肝硬化患者260例(LC组)和健康者106例(HC组),统计分析3组及不同分期AKI患者血清NGAL(sNGAL)、尿NGAL(uNGAL)、血清CysC和血清Cr(sCr)及其估算肾小球滤过率(eGFR:CysC-eGFR/c-aGFR)水平的差异性和相关性,并评估其对肝硬化继发AKI的诊断性能。结果 AKI组sNGAL、uNGAL、CysC和sCr水平高于LC组和HC组(P<0.01),CysC-eGFR和c-aGFR则相反,低于LC组和HC组(P<0.01)。随着AKI分期递增,患者sNGAL、uNGAL、CysC和sCr水平逐渐升高(P<0.01),c-aGFR和CysC-eGFR水平逐渐降低(P<0.01)。相关分析显示,sNGAL、uNGAL和CysC水平与sCr(r=0.662、0.672、0.726,P<0.01)呈正相关,与c-aGFR(r=-0.639、-0.661、-0.732,P<0.01)呈负相关;CysC-eGFR则反之,与sCr(r=-0.711,P<0.01)呈负相关,与c-aGFR(r=0.736,P<0.01)呈正相关。ROC曲线分析显示曲线下面积(AUC)以uNGAL最大(0.995),均显著高于sNGAL、sCr、CysC、c-aGFR和CysC-eGFR(P均<0.01);sNGAL的AUC次之,但仅高于c-aGFR和CysC-eGFR(P均<0.05),与sCr和CysC(P均>0.05)的AUC差异无统计学意义。uNGAL和sNGAL对肝硬化继发AKI的诊断有效性分别为0.962和0.920。结论对诊断肝硬化患者发生AKI,NGAL可能优于sCr和CysC,检测uNGAL比sNGAL能提高诊断性能。

Objective To investigate the clinical application of measurements of neutrophil gelatinase associated lipocalin in serum （sNGAL） and urine （uNGAL）,cystatin C （CysC） and serum creatinine （sCr） in diagnosis of acute kidney injury （AKI） patients secondary to liver cirrhosis （LC）.Methods A total of 260 liver cirrhosis patients without AKI （LC group）,207 liver cirrhosis patients with AKI （AKI group） and 106 healthy controls （HC group） were included in the study.The levels of sNGAL,uNGAL,serum creatinine （sCr）and cystatin C （CysC） were determined,respectively.The estimated glomerular filtration rate （eGFR） were calculated base on sCr and CysC,named as c-aGFR and CysC-eGFR.The differences and correlation of each observed parameters among the various groups were statistically analyzed,and the effectiveness of these parameters as biomarkers for predicting the development of AKI in these patients with liver cirrhosis were assessed.Results Compared with LC group and healthy control group,the levels of sNGAL,uNGAL,sCr and CysC in AKI group were significantly increased （all P〈0.01）,while the levels of c-aGFR and CysC-eGFR were significantly decreased （all P〈0.01）.Along with the progression of AKI stages,the levels of sNGAL,uNGAL,sCr and CysC in the patients were increasing （all P〈0.01）,while the levels of c-aGFR and CysC-eGFR were decreasing （all P〈0.01）.Correlation analysis showed that the levels of sNGAL,uNGAL and CysC were positively correlated with sCr （r = 0.662,0.672,0.726,all P〈0.01） and negatively correlated with c-aGFR （r =-0.639,-0.661,-0.732,all P〈0.01）.On the contrary,CysC was negatively correlated with sCr （r =-0.711,P〈0.01） and positively correlated with c-aGFR （r = 0.736,P〈0.01）.ROC curve analysis showed that the area under the curve （AUC） of uNGAL was maximum （0.995） which were significantly higher than that of sNGAL,sCr,c-aGFR,CysC and CysCeGFR （all P〈0.01）.The AUC of sNGAL did not present marked difference with that of sCr and CysC （P〈0.05）,but-was barely higher than that of c-aGFR and CysC-eGFR （P〈0.05）.The diagnostic effectiveness of uNGAL was maximum （0.962）,followed by sNGAL （0.920）.Conclusion For diagnosis of the development of AKI in the patients with liver cirrhosis,NGAL may be more reliable marker than sCr and CysC,and the detection of uNGAL could be more effective than sNGAL for the diagnosis.