NGAL、NAG和炎症指标对脓毒症患者急性肾损伤早期诊断的价值

Clinical significance of NGAL,NAG,and inflammation markers in early diagnosis of acute kidney injury in patients with sepsis

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、N-乙酰-β-D氨基糖苷酶(NAG)和血降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、WBC对脓毒症患者急性肾损伤(AKI)早期诊断的价值。方法回顾性分析60例脓毒症患者的临床资料,按照患者入ICU 7 d内是否出现AKI分为AKI组和非AKI组,各30例。分析比较两组患者血NGAL、尿NGAL、尿NAG和各项炎症指标的不同。运用ROC曲线评价各指标对AKI早期诊断的敏感性和特异性。结果两组比较,尿NGAL(log10)、血PCT、血hs-CRP的差异有统计学意义(P均<0.001)。两组血NGAL(log10)、尿NAG差异无统计学意义(P均>0.05)。ROC曲线:尿NGAL的AUC为0.882(P<0.001),血PCT的AUC为0.756(P<0.001),血hs-CRP的AUC为0.739(P=0.001);当尿NGAL≥155.5 ng/mL时,诊断早期AKI的敏感性为0.833,特异性为0.900;当血PCT≥1.08 ng/mL时,诊断的敏感性为0.600,特异性为0.833;当血hs-CRP≥93.5 mg/L时,诊断的敏感性为0.567,特异性为0.867。结论脓毒症患者尿NGAL、血PCT和hs-CRP升高,对AKI的早期诊断有一定的临床价值。

Objective To investigate the early diagnosis of acute kidney injury(AKI)using neutrophil gelatinaseassociated lipocalin(NGAL),N-acetyl-β-D-glucosaminidase(NAG),and PCT,hs-CRP,and white blood cell in sepsis patients.Methods Sixty sepsis patients’clinical data were studied,which were divided into two groups based on wheth⁃er AKI occurred within 7 days of ICU admission,30 cases in each group.Serum and urine NGAL,urine NAG,and three infective indicators were analyzed between groups.ROC curve method was used to calculate the sensitivity and specificity of the early diagnosis to AKI.Results There were significant differences in urine NGAL(log10),serum PCT,and blood hs-CRP between AKI and non-AKI groups(all P<0.001).There were no significant differences in serum NGAL(log10),urine NAG(all P>0.05).In ROC model,the areas under the curve(AUC)of urine NGAL,PCT,and hs-CRP were 0.882,0.756,and 0.739,respectively.When urine NGAL reached 155.5 ng/mL,the sensitivity and specificity of the early diagnosis of were 0.833 and 0.900,they were 0.600 and 0.833 when serum PCT reached 1.08 ng/mL,and 0.567 and 0.833 when hs-CRP reached 93.5 mg/L.Conclusion The increases of urine NGAL,serum PCT,and blood hs-CRP are benefit to the AKI's early diagnosis in sepsis patients.