万古霉素用药后血清NGAL水平与肾功能变化的相关性研究

The relationship between NGAL level and renal function in sepsis patients with vancomycin exposure

目的:探讨万古霉素暴露的脓毒症患者血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平与肾功能变化的相关性,评价其在预测万古霉素暴露患者早期肾损害中的作用。方法:以重症监护病房收治患者中接受万古霉素治疗并进行NGAL检测的脓毒症患者为研究对象。根据患者用药前NGAL水平,将纳入患者分为试验组和对照组2组,其中试验组为NGAL(+)组(≥50 ng·L-1),对照组为NGAL(-)组。分别记录2组患者用药前NGAL指标以及患者万古霉素用药前后血清肌酐(SCr)变化情况,白细胞计数(WBC)、C-反应蛋白(CRP)及降钙素原(PCT)等数据。以SCr绝对值增加>26.5μmol·L-1或增加达到基线值的1.5倍作为急性肾损伤(AKI)的诊断标准,评估NGAL水平与血肌酐变化、WBC、CRP及PCT之间的关系,比较NGAL(+)组和NGAL(-)组用药前后肌酐的变化情况及AKI发生率的统计学差异,并分析肾功能变化的影响因素。结果:本研究共纳入患者69例,其中试验组28例,对照组41例。万古霉素用药前、后对照组患者血肌酐水平分别为(79.6±22.4)μmol·L-1和(92.8±60.9)μmol·L-1,试验组患者用药前后的血肌酐水平分别为(89.9±22.8)μmol·L-1和(102.3±47.1)μmol·L-1。2组间及用药前后血肌酐值差异均无统计学意义(P>0.05)。血清NGAL与患者用药前后血肌酐变化水平无相关关系(P=0.168,R=0.176)。试验组与对照组AKI的发生率分别为32.14%和24.39%,试验组略高于对照组,但其差异无统计学意义(P>0.05)。试验组中NGAL水平与WBC、CRP及PCT水平之间均无明显的相关关系。结论:在患者入住ICU接受万古霉素治疗期间,血清NGAL尚不能证实单独作为万古霉素肾毒性的标记物。

OBJECTIVE To investigate the relationship between neutropil gelatinase-associated lipocalin(NGAL)level and renal function in sepsis patients with vancomycin exposure,and to evaluate NGAL in predicting early renal damage in patients with vancomycin exposure.METHODS The study was conducted in the ICU for the sepsis patients,who were treated with vancomycin and received NGAL tests.According to the level of NGAL before treatment,the patients were divided into two groups:the experimental group was NGAL(+)group(≥50 ng·L-1)and the control group was NGAL(-)group.NGAL parameters before treatment and changes in serum creatinine(SCr),white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)before and after vancomycin treatment were recorded in the two groups,respectively.The relationship between NGAL level and serum creatinine change,WBC,CRP and PCT was assessed by using the absolute increase of SCr>26.5μmol·L-1 or the increase reached 1.5 times of the baseline value as the diagnostic criteria for AKI,the statistical differences in the changes of creatinine and the incidence of acute kidney injury(AKI)before and after treatment in the NGAL(+)group were compared,and the influencing factors of the changes of renal function were analyzed.RESULTS A total of 69 patients were included in this study,including 28 patients in the experimental group and 41 patients in the control group.The serum creatinine levels were(79.6±22.4)μmol·L-1 and(92.8±60.9)μmol·L-1 in the control group before and after vancomycin treatment,and(89.9±22.8)μmol·L-1 and(102.3±47.1)μmol·L-1 in the test group before and after vancomycin treatment,respectively.There were no significant differences in serum creatinine values before and after treatment(P>0.05).There was no correlation between serum NGAL and serum creatinine change levels before and after treatment in patients(P=0.168,correlation coefficient R=0.176).The incidence of AKI in the test group was 32.14%and 24.39%,respectively,which was slightly higher in the test group than in the control group,but the difference was not statistically significant(P>0.05).There was no significant correlation between NGAL levels and WBC,CRP,and PCT levels.CONCLUSION Serum NGAL alone cannot be confirmed as a marker of vancomycin nephrotoxicity during ICU admission for vancomycin treatment.