血清NGAL和Cys C对慢加急性肝衰竭患者并发肝肾综合征早期诊断价值研究

Efficacy of serum neutrophil gelatinase associated apolipoprotein and cystatin C in early diagnosis of hepatorenal syndrome in patients with acute on chronic liver failure

目的研究血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和光抑素C(Cys-C)诊断慢加急性肝衰竭(ACLF)患者并发肝肾综合征(HRS)的价值。方法 2010年1月~2017年1月收治的204例ACLF患者,并发HRS58例。采用固相夹心酶联免疫吸附法检测血清NGAL,常规检测血清Cys-C、β2-微球蛋白(β2-MG)。绘制受试者工作特征曲线(ROC)评估血清指标诊断ACLF患者并发HRS的价值。结果 HRS与非HRS患者在性别、病程、BMI、糖尿病、血小板计数、血K+、平均动脉压方面比较无显著性差异(P>0.05),两组在年龄、高血压、冠心病、白细胞计数、白蛋白、蛋白尿、血尿素氮、血Na+和Child-Pugh评分方面存在明显差异(P<0.05);HRS患者NGAL、Cys-C、s Cr、β2-MG、BUN水平分别为(64.1±18.4)ng/m L、(3.1±1.1)mg/L、(165.8±25.7)mol/L、(6.3±2.1)mg/L、(12.6±4.3)mmol/L,显著高于无HRS组【(11.5±2.3)ng/m L、(1.2±0.4)mg/L、(62.6±11.4)mol/L、(2.7±1.2)mg/L、(4.1±1.5)mmol/L,P<0.05】;HRS组患者肝损伤程度显著重于无HRS组(P<0.05);血清NGAL和Cys-C诊断ACLF并发HRS的敏感度和准确度分别为(89.6%)和(92.1%),和85.9%和95.4%,显著高于血清s Cr、β2-MG或BUN,而NGAL联合Cys-C检测诊断的敏感度和准确度分别为92.1%和96.2%,明显优于血清NGAL或Cys-C单独检测。结论在ACLF患者中年龄越大,并发HRS的机会越大,病情重的患者血清NGAL和Cys-C水平升高,应用它们联合诊断ACLF患者并发HRS的效能较好,值得进一步研究。

Objective To investigate the efficacy of serum neutrophil gelatinase associated apolipoprotein(NGAL)and cystatin C(Cys C)in early diagnosis of hepatorenal syndrome(HRS)in patients with acute on chronic liver failure(ACLF).Methods The clinical data of 204 patients with acute on chronic liver failure in our hospital between January 2010 and January 2017 were retrospectively analyzed,and we found 58 patients having HRS.Serum NGAL,Cys-C,creatinine(Cr),β2-microglobulin(β2-MG)and urea nitrogen(BUN)were assayed.The diagnostic value of serum parameters in ACLF patients were investigated by the area under the receiver operator characteristic curve(AUROC).Results The gender,body mass index,course of disease,diabetes,platelet count,blood K+,mean arterial pressure were not significantly different between patients with HRS and those without(P>0.05),while there were obvious differences as respect to the age,hypertension,coronary heart disease,white blood cell count,albumin,proteinuria,blood urea nitrogen,blood Na+and Child-Pugh score between the two groups(P<0.05);serum NGAL,Cys-C,sCr,β2-MG and BUN levels in patients with HRS were(64.1±18.4)ng/mL,(3.1±1.1)mg/L,(165.8±25.7)μmol/L,(6.3±2.1)mg/L and(12.6±4.3)mmol/L,significantly higher than(11.5±.3)ng/mL,(1.2±0.4)mg/L,(62.6±11.4)μmol/L,(2.7±1.2)mg/L and(4.1±1.5)mmol/L in patients without HRS(P<0.05);serum parameters of liver functions such as serum bilirubin,and coagulation index in patients with HRS were more severe than those in patients without HRS(P<0.05);the sensitivity and accuracyof NGAL and Cys-C in diagnosing HRS were 89.6%and 92.1%,and 85.9%and 95.4%,respectively,significantly higher than those by serum Cr,β2-MG or BUN,and the sensitivity and accuracy of combination of NGAL and Cys-C were 92.1%and 96.7%,respectively,also significantly higher than those by NGAL or Cys-C alone.Conclusion The probability of hepatorenal syndrome occurrence in ACLF patients with old age is increasing,and the application of serum NGAL and Cys C in the early diagnosis and prediction of HRS in patients with ACLF is promising,which warrants further clinically observation.