血中性粒细胞明胶酶相关脂质运载蛋白及胱抑素C对输尿管结石梗阻致急性肾损伤的早期诊断价值

Early diagnosis of NGAL and cystatin C in acute renal injury caused by obstruction of ureteral calculi

目的评价血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及血清胱抑素C(Cys C)在输尿管结石梗阻所致急性肾功能损伤(AKI)的早期诊断价值,以及其在病情评估及疗效判定上的价值。方法回顾性分析2015年1月至2017年6月因输尿管结石梗阻于解放军第一七四医院住院治疗的患者临床资料,从中选取AKI患者32例,按急性肾损伤网络(acute kidney injury network,AKIN)诊断标准,将其分为AKI 1期组19例、AKI 2期组13例,另选取肾功能情况正常者30例为对照组。所有患者入院8 h内完善血NGAL、Cys C及肌酐(Scr)等相关检查,并于48 h内再次复查,如任意一次检查提示急性肾功能损伤,则急诊行输尿管镜检查及钬激光碎石术,术后留置输尿管内支架;如肾功能未见异常,择期行手术治疗,所有患者术后均再次复查。结果 AKI 2期组患者的Cys C、NGAL及Scr水平高于AKI 1期组,AKI 1期组高于对照组,差异有统计学意义(P<0.01);与治疗前比较,治疗后对照组Cys C、NGAL及Scr差异无统计学意义(P>0.01),治疗后AKI 1期组Scr及NGAL水平明显下降(P<0.01),治疗后AKI 2期组Cys C、NGAL及Scr水平明显下降(P<0.01)。患者血清NGAL与肌酐水平呈强线性相关(r=0.772,P<0.05),Cys C水平与肌酐呈中等强度相关(r=0.609,P<0.05),ROC曲线分析得知,NGAL的曲线下面积(AUC)为0.981,特异度为93.3%及敏感度为93.8%;Cys C的AUC为0.871,特异度为71.9%,敏感度为93.3%。结论 NGAL及Cys C作为一种早期诊断指标,能在一定程度上判定AKI的发生及程度,特别是NGAL在AKI诊断上特异性强,是一个敏感的生物学标志物。将NGAL及Cys C两者综合分析,对输尿管结石所致的AKI有更好的早期诊断价值。

Objective To evaluate the neutrophil gelatinase-associated lipocalin（ NGAL） and serum cystatin C（ Cys C） in the early diagnosis of acute renal dysfunction（ AKI） caused by obstruction of ureteral calculi,and it＇s significance in the assessment of AKI. Methods Retrospective analysis was performed which involved patients who were in the 174 th Hospital of PLA due to ureteral obstruction from January 2015 to June 2017,from which 32 cases of AKI patients were selected and divided into AKI 1 group 19 cases,AKI 2 group 13 cases. 30 cases in normal renal function were randomly selected as the control group. For all patients,blood NGAL,cystatin C and creatinine and other related examinations were performed within 8 h of admission,and were reviewed again within 48 h. If any of the relevant tests suggested acute renal dysfunction,the emergency ureteroscopy and holmium laser lithotripsy and indwelling ureteral stents after operative were performed. If renal function was abnormal,elective surgical treatment should be performed,and all patients were re-examined renal function after surgery. Results The levels of Cys C,NGAL and Scr in AKI 2 group were higher than those in AKI 1 group,and the levels of Cys C,NGAL and Scr in AKI 1 group were significantly higher than those in control group（ P〈0.01）. There were no significant differences in the levels of Cys C,NGAL and Scr in the control group before and after treatment（ P〈0.01）. The levels of Scr and NGAL in AKI 1 group were significantly lower than those before treatment（ P〈0.01）.The levels of Cys C,NGAL and Scr in AKI 2 group were significantly lower than those before treatment（ P〈0. 01）. A strong linear correlation between serum NGAL and creatinine levels（ r = 0.772,P〈0. 05） and moderate linear correlation between serum Cys C and creatinine levels（ r = 0. 609,P〈0. 05） was shown. ROC curve analysis indicated that the AUC of NGAL was 0.981,the specificity was 93.3% and the sensitivity was 93.8%. The AUC of Cys C was 0.871,the specificity was 71.9%,the sensitivity was 93.3%. Conlusion NGAL and Cys C as early diagnostic indexs can be more effective in predicting AKI,and to a certain extent they determine the occurrence and extent of AKI,especially NGAL. As sensitive biological markers,they have strong specificity and high sensitivity in the diagnosis of AKI. Both of the NGAL and Cys C can be combined and comprehensive analyzed,thus,the ureteral calculi caused by AKI could achieve better early diagnosis.