血清中性粒细胞明胶酶相关脂质运载蛋白对儿童急性心力 衰竭所致肾损伤的诊断价值

Diagnosis value of serum concentration of neutrophil gelatinase-associated lipocalin in worsening renal function in children with acute heart failure

目的:调查急性心力衰竭(acute heart failure,AHF)患儿血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)浓度,评估其在AHF患儿住院期间肾功能恶化(worsening renal function,WRF)中的诊断价值。方法:纳入2017年1月至12月于华中科技大学同济医学院附属武汉市中心医院诊断为AHF患儿30例为心力衰竭组,选取同期健康儿童20例为对照组。超声心动图评估心功能,在入院时(第1天)和入院后72 h(第3天)检测血液中尿素氮(blood ureanitrogen,BUN)、肌酐、NG AL浓度及肾小球滤过率(e-GFR)。结果:心力衰竭组入院时血清NGAL浓度显著高于对照组[(12.5±11.0) vs (4.5±3.0)μg/L,P<0.001],心力衰竭组72 h内有17例(56.6%)发生WRF,发生WRF的患儿入院时血清NGAL浓度显著高于未发生WRF的患儿[(38±10)vs(5.0±7.2)μg/L,P<0.001]。AHF患儿入院时血清NG AL截断值>27.5μg/L时,其诊断住院期间发生WRF的敏感性为87%,特异性为68%,曲线下面积(area under the curve,AUC)为0.869 (95%CI0.783～0.890,P<0.001),高于血清BUN(AUC=0.669)和e-GFR(AUC=0.714)。结论:血清NGAL具有良好的诊断AHF患儿WRF的能力,可作为儿童AHF肾功能损伤的标志物。

Objective： To investigate the serum concentration of neutrophil gelatinase-associated lipocalin（NGAL） in children with acute heart failure（AHF） and evaluate the diagnosis value of it in worsening renal function（WRF） in children with AHF during hospitalization. Methods： Thirty patients with AHF and 20 healthy children without AHF were enrolled in this study in our hospital from January 2017 to December 2017. The cardiac function was assessed by echocardiographic in all subjects. Blood urea nitrogen（BUN）, creatinine, NGAL concentrations and glomerular filtration rate were measured at admission（Day 1） and 72 h after admission（Day 3）. Results： Serum NGAL concentrations was significantly higher in children with AHF than the children without AHF [（12.5±11.0） vs（4.5±3.0） μg/L, P〈0.001]. Seventeen（56.6%） children suffered WRF during hospitalized within 72 h. Serum NGAL concentrations was significantly higher in children accompanied WRF than those without WRF [（38±10） vs（5.0±7.2） μg/L, P〈0.001]. When the serum NGAL concentrations cutoff value was 27.5 μg/L, NGAL concentration can diagnosis the WRF in AHF children with a sensitivity of 87%, specificity of 68%, and the area under the curve（AUC） of 0.869（95% CI 0.783–0.890, P〈0.001）, which was higher than serum BUN（AUC=0.669） and e-GFR（AUC=0.714）. Conclusion： Serum NGAL has a good ability to diagnose renal function deterioration in hospitalized children with AHF and can be used as a marker of renal impairment in children with AHF.