中性粒细胞明胶酶相关脂质运载蛋白在心肾综合征中的早期诊断价值

Early diagnostic value of neutrophil gelatinase-associated lipid-carrying proteins in cardiorenal syndrome

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在心肾综合征(CRS)中的早期诊断价值。方法选取2017年11月~2018年10月上饶市人民医院收治的165例心力衰竭(HF)患者作为研究对象,根据CRS诊断指南标准筛选出38例急性失代偿性心力衰竭(ADHF)合并新型急性肾损伤(AKI)患者作为CRS组,其余127例为对照组。比较两组患者的尿液NAGL(uNGAL)、N-末端脑钠肽前体(N-proBNP)、胱蛋白酶抑制剂(Cys-C)、尿素氮(BUN)、肌酐(SCr)水平,并分别检测CRS组患者0(基线)、2、4、8、18、48 h的uNGAL、SCr、Cys-C、BUN水平,应用受试者操作特征(ROC)曲线分析uNGAL诊断CRS的价值。结果CRS组患者的SCr、BUN、uNGAL、Cys-C、NT-proBNP水平均高于对照组,差异有统计学意义(P<0.05)。CRS组患者48 h的SCr、BUN水平均显著高于基线,差异有统计学意义(P<0.05);CRS组患者2、4、8、18、48 h的uNGAL水平均明显高于基线,差异有统计学意义(P<0.05),且2、4 h达峰值;CRS组患者4、8、18、48 h的Cys-C水平均高于基线,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,2、4、8、18 h uNGAL诊断AKI的AUC分别为0.879、0.862、0.848、0.813,95%CI:0.768~0.981、0.735~0.977、0.723~0.971、0.741~0.954,以169.1 ng/ml作为诊断AKI的截取值时,其灵敏度和特异度分别为95.61%和87.52%。结论uNGAL与ADHF患者住院期间发生AKI有关,是HF患者住院期间肾功能恶化的早期独立预测指,在CRS患者的早期诊断和早期干预治疗方面具有重要意义。

Objective To investigate the early diagnostic value of neutrophil gelatinase-associated lipid-carrying proteins(NGAL)in cardiorenal syndrome(CRS).Methods A total of 165 patients with heart failure(HF)who were admitted to Shangrao People′s Hospital from November 2017 to October 2018 were seleted as the research objects.According to the CRS diagnostic guidelines,38 patients with acute decompensated heart failure(ADHF)and new acute kidney injury(AKI)were selected as the CRS group,and the remaining 127 patients were assigned as the control group.The urine NGAL(uNGAL),N-terminal pro-brain natriuretic peptide(N-proBNP),cystatin(Cys-C),urea nitrogen(BUN),and creatinine(SCr)levels were compared between the two groups.The levels of uNGAL,SCr,Cys-C and BUN at 0(baseline),2,4,8,18,48 h of CRS group were detected respectively.The value of uNGAL in the diagnosis of CRS was analyzed by receiver operating characteristic(ROC)curve.Results The levels of SCr,BUN,uNGAL,Cys-C and NT-proBNP in the CRS group were higher than those in the control group,and the differences were statistically significant(P<0.05).The SCr and BUN levels in the CRS group at 48 h were significantly higher than those at the baseline,and the differences were statistically significant(P<0.05).The levels of uNGAL in the CRS group at 2,4,8,18,and 48 h were significantly higher than those at the baseline,the differences were statistically significant(P<0.05),and peaked at 2 and 4 h.The Cys-C levels at 4,8,18,and 48 h in the CRS group were higher than those at the baseline,and the differences were statistically significant(P<0.05).The ROC curve analysis showed that the AUC of the diagnosis of AKI at 2,4,8,and 18 h were 0.879,0.862,0.848,and 0.813,95%CI was 0.768-0.981,0.735-0.977,0.723-0.971,and 0.741-0.954,respectively.When 169.1 ng/ml was used as the cut-off value for the diagnosis of AKI,the sensitivity and specificity were 95.61%and 87.52%,respectively.Conclusion The uNGAL is associated with AKI in patients with ADHF during hospitalization,and it is an early independent predictor of renal function deterioration during hospitalization of HF patients,which is of great significance in the early diagnosis and early intervention of CRS patients.