心脏瓣膜术后患者血清中性粒细胞明胶酶相关脂质运载蛋白表达水平及其临床意义分析

Expression of serum neutrophil gelatinase-associated lipocalin in patients after cardiac valve surgery and its clinical significance

目的探讨心脏瓣膜术后患者血清中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)表达水平及其临床意义。方法连续性纳入2017年3月至2018年3月陕西省人民医院收治的83例心脏瓣膜术后患者,将左心室射血分数(left ventricle ejection fraction,LVEF)<50%的患者纳入研究组(36例),其余患者纳入对照组(47例)。比较两组患者一般临床资料、手术资料、心肺肾脏器功能损伤程度、血清NGAL水平,并分析血清NGAL水平与患者肾功能指标及心功能指标的相关性。结果研究组患者年龄、急性生理与慢性健康评分、序贯性器官衰竭评分、肌酐、肌钙蛋白I、B型利钠肽(B-type natriuretic peptide,BNP)、NGAL、乳酸水平均高于对照组(均P<0.05),手术时间、体外循环时间、机械通气时间、住院时间及住ICU时间均显著长于对照组(均P<0.05),术中出血量多于对照组(P<0.05),肌酐清除率、LVEF、pH及氧合指数均显著低于对照组(均P<0.05)。血清NGAL水平与肌酐、BNP水平显著正相关(r=0.671、0.576,P=0.024、0.014),与肌酐清除率、LVEF显著负相关(r=-0.218、-0.321,P=0.041、0.023)。结论血清NGAL水平可作为反映心脏瓣膜术后患者心功能水平的生物标记物。

Objective To investigate the expression and clinical significance of serum neutrophil gelatinase-associated lipocalin(NGAL) in patients after cardiac valve surgery. Method 83 patients with cardiac valve surgery admitted to Shaanxi Provincial People’s Hospital from March 2017 to March 2018 were enrolled. Patients with left ventricle ejection fraction(LVEF) <50% were included in study group(36 patients), the remaining patients were included in control group(47 cases). The clinical data, surgical data,heart, lung and kidney function damage, serum NGAL levels were compared between two groups, and the correlation between serum NGAL levels and patients’ cardiac and renal function indexes were analyzed. Result The age, acute physiology and chronic health evaluation, sequential organ failure assessment, creatinine, troponin I, B-type natriuretic peptide(BNP), NGAL, and lactic acid levels were higher in study group than that of control group(all P<0.05);the operation time, cardiopulmonary bypass time, mechanical ventilation time, hospital stay and ICU time were significantly longer than that of control group.(all P<0.05);observation group had more bleeding than the control group(P<0.05);the creatinine clearance rate, LVEF, pH and oxygenation index of observation group were significantly lower than control group(all P<0.05). Serum NGAL level was positively correlated with creatinine and BNP levels(r=0.671, 0.576, P=0.024, 0.014), and was significantly negatively correlated with creatinine clearance and LVEF(r=-0.218、-0.321,P =0.041、0.023). Conclusion Serum NGAL level can be used as biomarkers to reflect cardiac function in patients after cardiac valve surgery.