多指标联合检测对老年急性百草枯中毒患者肾损伤的早期诊断价值

Value of combined detection of neutrophil gelatinase-associated lipocalin,cystatin C and heme oxygenase-1 in early diagnosis of renal injury in patients with acute paraquat poisoning

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(CysC)、血红素氧合酶-1(HO-1)联合检测在老年急性百草枯中毒(APP)所致急性肾损伤(AKI)患者中的早期诊断价值。方法回顾性分析,将2015年5月至2019年6月入住我院急救医学部的老年APP患者102例设为观察组,健康体检者50例设为对照组。观察组患者按入院72 h是否发生AKI分为AKI组59例和非AKI组43例。所有APP患者分别于入院即刻(0 h)、12 h、24 h、48 h、72 h检测血NGAL、CysC、HO-1、血肌酐(Scr);对照组患者体检当日检测上述指标。分析血NGAL、CysC及HO-1水平和发生AKI的相关性,绘制受试者工作特征曲线(ROC)分析NGAL、CysC、HO-1及三者联合对APP患者早期肾损伤的诊断价值。结果0 h NGAL、CysC、HO-1及Scr水平AKI组、非AKI组、对照组两两比较差异均无统计学意义(均P>0.05);观察组患者入院后各指标均呈上升趋势,12 h后AKI组与非AKI组NGAL、CysC、HO-1比较差异均有统计学意义(均P<0.05);72 h后AKI组与非AKI组Scr比较差异有统计学意义(P<0.05)。相关性分析结果显示,12、24、48、72 h NGAL、CysC、HO-1水平与APP患者AKI的发生均呈正相关,48 h相关性最强(NGAL:r=0.203、0.545、0.707、0.560,均P<0.05;CysC:r=0.242、0.340、0.754、0.467,均P<0.05;HO-1:r=0.249、0.536、0.677、0.509,均P<0.05)。绘制48 h时NGAL、CysC、HO-1、Scr及NGAL+CysC+HO-1对AKI预测的ROC曲线下面积分别为0.777、0.718、0.888、0.602、0.969。结论老年患者APP后12 h血NGAL、CysC、HO-1水平即可明显升高,48 h达高峰,其诊断AKI的时间明显早于Scr,三者联合诊断价值更高。

Objective To investigate the value of combined detection of neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(CysC)and heme oxygenase-1(HO-1)in the early diagnostic of acute kidney injury(AKI)caused by acute paraquat poisoning(APP)in elderly patients.Methods One hundred and two elderly APP patients admitted to the emergency department of our hospital from May 2015 to June 2019 were assigned to the observation group,and 50 patients who took physical examinations served as the control group.The observation group was divided into the AKI sub-group(n=59)and the non-AKI sub-group(n=43)based on whether AKI occurred within 72 h of admission.Serum levels of NGAL,CysC,HO-1 and creatinine(Scr)were detected in all APP patients at 0 h(admission),12 h,24 h,48 h and 72 h.Measurements of the same parameters were made on the day of physical examination for the control group.The correlations of serum levels of NGAL,CysC and HO-1 with the occurrence of AKI were analyzed.Relative operating characteristic curve(ROC)was drawn to analyze the diagnostic value of NGAL,CysC,HO-1 and the combination of the three for the early diagnosis of renal injury in APP patients.Results Serum levels of NGAL,CysC,HO-1 and Scr at admission showed no significant difference between the AKI sub-group,non-AKI sub-group and control group(P>0.05).After admission,all the parameters showed an upward trend in the observation group.Serum levels of NGAL,CysC and HO-1 at 12 h after admission(P<0.05)and Scr levels at 72 h after admission(P<0.05)were significantly different between the AKI sub-group and the non-AKI sub-group.Correlation analysis showed that serum NGAL,CysC and HO-1 levels were positively correlated with the occurrence of AKI in APP patients at 12 h,24 h,48 h and 72 h after admission,with the best correlation at 48 h after admission(NGAL:r=0.203,0.545,0.707 and 0.560,P<0.05;CysC:r=0.242,0.340,0.754 and 0.467,P<0.05;HO-1:r=0.249,0.536,0.677 and 0.509,P<0.05).The area under ROC curve predicted by NGAL,CysC,HO-1,Scr and NGAL+CysC+HO-1 for AKI at 48 h after admission was 0.777,0.718,0.888,0.602 and 0.969,respectively.Conclusions Serum levels of NGAL,CysC and HO-1 are significantly elevated at 12 h after admission in elderly APP patients,and reach the peak at 48 h after admission.Each of them can give an earlier diagnosis for AKI than Scr,and the combination of the three provides a higher diagnostic accuracy for AKI.