中性粒细胞明胶酶相关脂质运载蛋白在评价活体供肾切取术后残肾功能中的临床意义

Clinical significance of neutrophil gelatinase-associated lipocalin in evaluating residual renal function after living donor kidney resection

目的探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在评价不同年龄、不同术式活体供肾切取术后残肾功能的l临床意义。方法回顾性分析2016年9月至2017年10月在郑州大学第一附属医院成功实行亲属活体肾移植的66例供者临床资料。根据术式、年龄将供者分为4组：青年开放组、青年腔镜组、中老年开放组、中老年腔镜组；记录供者术前及术后l、3和7d血、尿NGAL、血肌酐和胱抑素C等肾功能监测指标。结果4组的术前血、尿NGAL差异无统计学意义（P〉0．05）；术后第1天老年开放组尿NGAL均高于其他3组（P〈0．05），青年开放组尿NGAI。的表达高于青年腔镜组（P〈0．05），4组血NGAL比较差异无统计学意义（P〉0．05）；术后第3天中老年开放组血NGAL高于中老年腔镜组（P〈0．05）。结论NGAI，可作为活体供肾切取术后残肾功能的评估指标，尤其在评估中老年及开放性供肾的残肾功能时更为敏感，有助于早期发现供者术后急性肾损伤。

Objective To investigate the clinical significance of serum and urinary levels of neutrophil gelatinase-assoeiated lipocalin （NGAL） for evaluating changes of residual renal function after living donor kidney resection under different operation model in young versus elderly patients. Methods The clinical data of renal transplants were retrospectively analyzed by successfully using 66 living-related donors at the First Affiliated Hospital of Zhengzhou University from September 2016 to October 2017. According to the operation model and age, renal donors were divided into 4 groups： group A （young/open）, group B （young/laparoscopic）, group C （aged/open）, and group D （aged/ laparoscopic）. Blood and urinary NGAL and serum levels of creatinine,cystatin C,and other indices of renal function were assayed and collected before and at 1,3,7 days after operation. Results Both blood NGAL levels and urinary NGAL levels showed no statistically significant difference （all P 0.05） among four groups both before and after operation, except that urinary NGAL was higher in group C （aged/open） than other groups, at 1 day after operation, （P = 0.03） . The post-vs, pre- operation level dynamic changes of renal function were four or three times higher in urine or serum NGAL level than in serum creatinine or cystatin C level at 1 day after operation, which showed an important role for predicting an early residual renal damage and relative treatment. Conclusions NGAL can be used as indices in evaluating changes of residual renal function after living donor kidney resection, especially in the elderly receiving open kidney resection.