中性粒细胞明胶酶相关脂质运载蛋白在先天性心脏病介入治疗后对比剂相关肾病中的诊断价值

Diagnostic value of neutrophil gelatinase-associated lipocalin in contrast related nephropathy after interventional therapy for congenital heart disease

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在先天性心脏病介入治疗后对比剂相关性肾病中的诊断价值。方法纳入2016年1月至2016年12月在华中科技大学同济医学院附属协和医院行先天性心脏病介入封堵术的患者386例,其中34例术后出现急性肾损伤(AKI),为AKI组,随机数字表选取34例未出现AKI的患者设为非AKI组。比较两组患者术前、术后3 h、6 h、24 h、48 h、72 h血清肌酸酐(SCr)和尿NGAL水平,并分析AKI组的SCr和NGAL的ROC曲线,对比SCr和NGAL在各时间点的诊断价值。结果两组患者术前、术后3 h、6 h、24 h SCr水平比较,差异均无统计学意义(均P>0.05);AKI组患儿术后48 h、72 h SCr水平明显高于非AKI组,而AKI组患者尿NGAL水平术后3 h[(16.32±4.07)ng/ml比(10.03±1.64)ng/ml,P<0.001]、6 h[(25.06±7.70)ng/ml比(10.68±1.48)ng/ml,P<0.001]、24 h[(32.15±8.73)ng/ml比(10.15±1.73)ng/ml,P<0.001]、48 h[(46.09±5.80)ng/ml比(9.97±1.03)ng/ml,P<0.001]和72 h[(76.00±7.74)ng/ml比(9.76±0.78)ng/ml,P<0.001]显著大于非AKI组,差异均有统计学意义。ROC曲线下面积分析显示,各时间点SCr的曲线下面积明显小于尿NGAL。术后3 h,NGAL≥11.5 ng/m L诊断AKI的敏感度为88.2%,特异度为85.3%;术后6 h,NGAL≥13.5 ng/m L诊断AKI的敏感度为91.2%,特异度为97.1%。结论尿NGAL是早期诊断肾损伤的高敏感度和特异度指标。

Objective To investigate the diagnostic value of urinary neutrophil gelatinase -associated lipocalin（NGAL） in contrast related nephropathy after interventional therapy for congenital heart disease. Methods A total of 386 cases who received interventional therapy for congenital heart disease between January 2016 to December 2016 in our hospital were studied. There were 34 cases with acute kidney injury （AKI） developed after intervention and they were classified as the AKI group, Another 34 cases without AKI were randomly selected from the same period and classified as the non-AKI group. Samples for urinary NGAL and serum creatinine （SCr） were taken 24 hours before and at 3, 6, 24, 48 and 72 hours after intervention. ROC curves of SCr and NGAL of the AKI group were analyzed and the diagnostic value of SCr and urinary NGAL were compared. Results There were no significant differences in SCr levels between the two groups at before and until 24 hours after intervention （all P 〉 0.05）. The Scr in the AKI group was significantly higher than that in the non-AKI group at 48 hours after intervention, while significant difference in NGAL between the two groups appeared since 3 hours after intervention. The ROC curve analysis of SCR and NGAL at each time point showed that the area under the curve of NGAL was significantly larger than that of SCr. NGAL measured at 3 hours post procedure with levels 〉~ 11.5 ng/ml showed diagnostic value （sensitivity 88.2%, specificity 85.3%）. When NGAL was greater than 13.5 ng/ml at measured at 6 hours post procedure, the sensitivity of diagnosis of AKI was 91.2%, and specificity was 97.1%. Conclusions Urinary NGAL is an indicator with high sensitivity and specificity for early diagnosis of contrast related nephropathy.