血清NGAL联合肌酐早期判断乙型肝炎肝硬化患者并发肝肾综合征的临床价值分析

Clinical application of serum neutrophil gelatinase associated apolipoproteins and serum creatinine in the early diagnosis of hepatorenal syndrome in patients with liver cirrhosis

目的研究血清中性粒细胞明胶酶相关载脂蛋白(NGAL)联合血清肌酐(s Cr)在早期诊断肝炎肝硬化患者并发肝肾综合征(HRS)的临床价值,旨在为提高早期诊断肝炎肝硬化并发肝肾综合征提供有效的诊断依据。方法 2014年3月~2017年3月我院收治的108例乙型肝炎肝硬化患者,回顾性分析其临床资料。发现并发HRS患者45例,非HRS患者63例,另选同期在我院进行健康体检的正常人66例作为对照组。采用固相夹心酶联免疫吸附法检测血清NGAL,采用肌氨酸氧化酶法检测s Cr,计算24 h内肌酐清除率(24-Ccr)。采用受试者工作特征曲线(ROC)下面积评价血清NGAL和s Cr诊断存在HRS的效能。结果 HRS患者血清NGAL和s Cr水平分别为(64.1±18.4)ng/ml和(109.6±24.5)μmol/L,显著高于非HRS组【(10.6±3.1)ng/ml和(88.2±15.7)μmol/L,P<0.05】或正常人【(8.3±2.2)ng/ml和(82.6±14.3)μmol/L,P<0.05】,而非HRS患者血清NGAL和s Cr水平与对照组比较无显著差异(P>0.05);经Spearman相关性分析显示,血清NGAL和s Cr水平与24-Ccr呈负相关(r=-0.768,P<0.01;r=-0.721,P<0.01);应用NGAL和s Cr诊断HRS的ROC曲线下的面积为0.895(0.860~0.912),其灵敏度为82.5%,特异度为83.4%,正确性为75.84%,明显高于血清NGAL或s Cr单项检测【ROCNGAL曲线下面积为0.751(0.708~0.794),灵敏度为75.3%,特异度为84.5%,正确性为63.84%;ROCs Cr曲线下面积为0.743(0.714~0.772),灵敏度为73.2%,特异度为66.8%,正确性为56.38%】。结论应用血清NGAL比s Cr能更准确地早期诊断肝炎肝硬化患者并发肝肾综合征,而两者联合检测的灵敏度和特异度更高,可提高早期诊断率。

Objective To investigate the clinical application of serum neutrophil gelatinase associated apolipoproteins（NGAL） and serum creatinine（s Cr） in the early diagnosis of hepatorenal syndrome（HRS） in patients with liver cirrhosis.Methods The clinical data of 108 patients with hepatitis B-induced liver cirrhosis in our hospital between March 2014 and March 2017 were retrospectively analyzed.Out of them,45 patients had HRS,and 63 had not.66 persons for physical examination at the same time in our hospital were selected for the control.Serum NGAL and Cr in three groups were determined routinely.The early diagnostic value of serum NGAL and Cr in patients with hepatitis B cirrhosis complicated by HRS was analyzed by area under ROC.Results Serum NGAL and Cr levels in HRS group were（64.1±18.4） ng/ml and（109.6±24.5） μmol/L,which were significantly higher than [（10.6±3.1） ng/ml and（88.2±15.7） μmol/L,P〈0.05] in patients without HRS or [（8.3±2.2）ng/ml and（82.6±14.3） μmol/L,P〈0.05] in the control,and serum NGAL and Cr levels were not significant different between the control group and non-HRS group（P 〉0.05）;The Spearman correlation analysis showed that serum NGAL and Cr were negatively correlated with 24-Ccr（r =-0.768,P 〈0.01;r =-0.721,P〈 0.01）;The AUC of combination of NGAL and s Cr in the diagnosis of HRS was 0.895（0.860-0.912） with a sensitivity of 82.5%,the specificity of 83.4% and the accuracy of 75.8%,which were significantly higher than those by any of the single parameters [the AUC of ROCNGALwas 0.751（0.708-0.794） with a sensitivity of 75.3%,specificity of 84.5% and the accuracy of 63.84%;and the AUC of the ROCs Crwas 0.743（0.714-0.772） with a sensitivity of 73.2%,a specificity of 66.8% and the accuracy of 56.38% ].Conclusion The application of serum NGAL in the early diagnosis of hepatorenal syndrome in patients with liver cirrhosis is helpful,and the sensitivity and specificity of combination of serum NGAL and Cr is more practical,which can improve the early diagnosis of hepatorenal syndrome in patients with liver cirrhosis.