血清NGAL在原发性高血压患者早期肾损害及其预后危险分层中的应用价值探讨

The Application Value of Serum NGAL in the Early Renal Damage and Risk Stratification in Patients with Essential Hypertension

目的探讨血清NGAL(中性粒细胞明胶酶相关脂质运载蛋白)在原发性高血压(essential hypertention,EH)患者早期肾损害及高血压肾病(essential hypertensive kidney disease,EKD)危险分层中的应用价值。方法选取EKD组204例,EH组517例,健康对照(healthy controls,HC)组150例,收集其血清尿素(Urea)、肌酐(Creatinine,Cr)、胱抑素C(cystatin C,CysC)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、NGAL、补体C1q和尿蛋白/肌酐比值(albumin/creatinine ratio,ACR)等结果,以ACR与eGFR水平对EKD进行不良预后危险分层。分析以上指标与高血压患者肾损害发生的关联程度,采用ROC比较各指标单独或联合诊断EKD的性能,重点观察NGAL、Cr、Ure与Clq在EKD不良预后危险分层中的变化。结果所观察的肾损害指标,在EH与HC间除Ure外差异均有统计学意义(P<0.05),在EH与EKD间除C1q外差异均有统计学意义(P<0.05);与Ure、Cr和C1q相比,ACR、eGFR、NGAL与EKD发生关系更加密切(P<0.05);各指标检测诊断EKD的AUC大小依次为ACR(0.888)、eGFR(0.877)、NGAL(0.856)、Cr(0.820)、Ure(0.717)、Clq(0.548),eGFR/ACR/NGAL联合诊断模式的效能(AUC=0.981)显著高于其他模式(P<0.05);NGAL与Cr在肾损害危险分层中逐层增高,且在相邻两层间差异均有统计学意义(P<0.05)。结论血清NGAL对EKD有较好的诊断价值,可作为EKD患者早期肾损害的补充诊断指标。

Objective To investigate the clinical value of serum NGAL in the early renal damage in patients with essential hypertension(EH)and risk stratification of essential hypertensive kidney disease(EKD).Methods We enrolled the Select EKD group with 204 cases,EH group with 517 cases,and healthy controls(HC)group with 150 cases.The results of subjects’serum urea(Ure),creatinine(Cr),urinary cystatin C(CysC),estimated glomerular filtration rate(eGFR),neutrophil enzyme related lipid carrier protein gelatin(NGAL),complement C1q and urinary albumin/creatinine ratio(ACR)were collected,The EKD was stratified with adverse prognosis risk at the levels of ACR and eGFR.The correlation between the above indexes and the occurrence of renal damage in patients with hypertension was analyzed.ROC was applied to compare the performance of each indicator individually or jointly to diagnose EKD.Meanwhile,the changes of NGAL,Cr,Ure and Clq in the risk stratification of kidney damage were particularly observed.Results The observed renal damage indexes were significantly different between EH and HC except for Ure(P<0.05),and between EH and EKD except for C1q(P<0.05).Compared with Ure,Cr and C1q,ACR,eGFR and NGAL were more closely related to EH kidney damage(P<0.05).The AUCs of EKD were as following:ACR(0.888),eGFR(0.877),NGAL(0.856),Cr(0.820),Ure(0.717)and Clq(0.548).The efficiency of the joint diagnostic mode of eGFR/ACR/NGAL(AUC=0.981)was significantly higher than that of individual modes(P<0.05).NGAL and Cr increased layer by layer in the renal injury risk stratification,and the difference between the two adjacent layers was significant(P<0.05).Conclusion Serum NGAL has a good diagnostic value for EKD and can be used as a supplementary diagnostic index for the early renal damage in EH patients.