血清NGAL和CysC用于重型颅脑损伤患者并发急性肾损伤的诊断价值研究

The diagnostic value of serum levels of NGAL and CysC in diagnosis of severe traumatic brain injury complicated by acute kidney injury

目的探讨血清中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)和半胱氨酸蛋白酶抑制剂C(cystatin C,Cys C)用于重型颅脑损伤患者并发急性肾损伤(acutekidneyinjury,AKI)的诊断价值。方法纳入2013年2月至2016年10月住院的重型颅脑损伤患者89例,根据是否发生AKI分为AKI组(n=41)和无AKI组(n=48);检测患者血清NGAL和Cys C水平,分析NGAL和Cys C与临床指标的相关性;使用ROC曲线评估NGAL及Cys C的诊断价值。结果与无AKI组比较,AKI组NGAL[(86. 13±33. 51、59. 99±22. 96) ng/ml]及Cys C水平[(1. 58±0. 66、0. 96±0. 46)μg/dl]均显著升高(P <0. 01)。AKI组中,NGAL分别与s Cr(r=0. 516,P=0. 01)、BUN(r=0. 484,P=0. 01)、GCS(Rs=0. 545,P <0. 01)、SOFA评分(Rs=0. 521,P <0. 01)、AKI分期(Rs=0. 794,P <0. 01)呈正相关,与e GFR(r=-0. 474,P <0. 01)呈负相关; Cys C与血清肌酐(serum creatinine,SCR)(r=0. 476,P <0. 01)、BUN(r=0. 406,P=0. 008)、GCS(Rs=0. 400,P=0. 008)、SOFA评分(Rs=0. 443,P=0. 004)、AKI分期(Rs=0. 387,P=0. 012)呈正相关,与e GFR(r=-0. 504,P <0. 01)呈负相关。NGAL诊断AKI的AUC为0. 725 (95%CI:0. 619～0. 831),Cys C的AUC为0. 779(95%CI:0. 683～0. 875),NGAL联合Cys C的AUC为0. 833(95%CI:0. 744～0. 921)。结论血清NGAL和Cys C水平在重型颅脑外伤并发AKI时显著升高,且两者联合诊断s TBI相关AKI的临床价值较高。

Objective To investigate the diagnostic value of serum neutrophil gelatinase associated lipocalin(NGAL)and cystatin C(CysC)in patients with severe traumatic brain injury(sTBI)complicated by acute kidney injury(AKI).Methods A total of 89 patients with sTBI who were treated in our hospital from February 2013 to October 2016 were enrolled in the study,and these patients were divided into AKI group(n=41)and non-AKI group(n=48).The serum levels of NGAL and CysC were detected,and the correlation between NGAL(or CysC)and clinical indexes was analyzed.The application value of NGAL and CysC in diagnosis of sTBI with AKI was evaluated by means of ROC curve.Results As compared with those in non-AKI group,the NGAL levels[(86.13±33.51)vs.(59.99±22.96)ng/ml]and CysC levels[(1.58±0.66)vs.(0.96±0.46)μg/dl]in AKI group were significantly increased(P<0.01).In AKI group,the NGAL levels were positively with sCr,BUN,GCS,SOFA score and AKI stage(P<0.01),however,which were negatively correlated with eGFR(P<0.01).Moreover the CysC levels were positively with sCr,BUN,GCS,SOFA score and AKI stage(P<0.01),however,which were negatively correlated with eGFR(r=-0.504,P<0.01).In addition the AUC of NGAL in diagnosis of AKI in patients with sTBI was 0.725(95%CI:0.619~0.831),and AUC of CysCwas was 0.779(95%CI:0.683~0.875),moreover,the AUC of NGAL combined with CysC was 0.833(95%CI:0.744~0.921).Conclusion The levels of NGAL and CysC are obvously increased in patients with sTBI complicated by AKI,and the combination detection of NGAL and CysC has important diagnostic value in diagnosis of AKI in patients with sTBI.