并发急性肾损伤早产儿尿中性粒细胞明胶酶相关脂质运载蛋白水平检测及其临床意义

Detection of urinary neutrophil gelatinase associated lipocalin level of premature infants with acute kidney injury and its clinical significance

目的:对比急性肾损伤(AKI)和非AKI早产儿尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL水平,探讨尿NGAL水平对早产儿AKI早期诊断的临床价值。方法:将85例早产儿按是否发生AKI分为AKI组(n=30)和非AKI组(n=55)。于生后24、48、72、120和168h采用酶联免疫吸附(ELISA)法检测2组早产儿尿NGAL水平,采用干化学法检测2组早产儿血清肌酐(Scr)水平。并采用受试者工作特征(ROC)曲线判断各指标的诊断价值。结果:2组早产儿性别、孕周、出生体质量、入住NICU时的年龄比较差异均无统计学意义(P>0.05)。2组早产儿各时间点尿NGAL水平比较差异有统计学意义(F=62.710,P<0.01),生后24h开始升高,72h达最高峰值,72h后呈下降趋势。AKI组早产儿在生后24、48、72和120h时尿NGAL水平均高于非AKI组(P<0.05),2组早产儿各时间点Scr水平比较差异有统计学意义(F=27.332,P<0.05),AKI组早产儿生后48、72和120h时Scr水平均高于非AKI组(P<0.05)。生后24h时尿NGAL水平诊断AKI的ROC曲线下面积(AUC)明显大于Scr水平(P<0.01),当尿NGAL水平的临界值为6.95ng·dL^-1时,诊断AKI的敏感性和特异性分别为0.900和0.836。结论:尿NGAL水平可以高效预测早产儿AKI。

Objective:To compare the urinary neutrophil gelatinase-associated lipocalin(NGAL)levels in the acute kidney injury(AKI)and non-AKI premature infants,and to explore the clinical value of NGAL level in the early diagnosis of AKI.Methods:A total of 85 premature infants were divided into AKI group(n=30)and nonAKI group(n=55)according to whether AKI occurred.The levels of urinary NGAL were detected by enzymelinked immunosorbent assay(ELISA)method at 24,48,72,120,and 168 hafter birth.The levels of serum creatinine(Scr)of preterm infants were detected by dry chemical method.The receiver operation cllaracteristics(ROC)curve is used to judge the diagnostic value of each indicator.Results:There were no significant differences in gender,gestational ages,body weights at birth,ages at NICU of the premature infants between two groups(P>0.05).There were significant differences in the urinary NGAL levels of the premature infants between two groups at different time points(F=62.710,P<0.01);the urinary NGAL level was increased at 24 hafter birth,reached the highest peak at 72 hafger birth,and decreased from 72 hafter birth.The urinary NGAL levels of the premature infants in AKI group were higher than those in non-AKI group at 24,48,72 and 120 hafter birth(P<0.05).There were statistically significant differences in the Scr levels of the pretmature infants between two groups at different time points(F=27.332,P<0.05).The Scr levels of the premature infants in AKI group were higher than those in non-AKI group at 48,72 and 120 hafter birth(P<0.05).The area under ROC curve(AUC)of urinary NGAL level at 24 after birth was significantly greater than that of Scr level(P<0.01).When the cutoff value of urinary NGAL level was 6.95 ng·dL^-1,the sensitivity and specificity of urinary NGAL level in diagnosis of AKI were 0.900 and 0.836,respectively.Conclusion:The level of urinary NGAL can effectively predict the AKI in the premature infants.