中性粒细胞明胶酶相关脂质运载蛋白对高血压病合并颈动脉粥样硬化的诊断价值

Diagnostic value of neutrophil gelatinase associated lipocalin in patients with hypertension complicated with carotid atherosclerosis

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对高血压病患者发生颈动脉粥样硬化的诊断价值及与颈动脉斑块状态的关系。方法选取2017年10月9日至2018年8月17日在江苏盛泽医院体检的高血压患者112例,根据有无颈动脉粥样硬化分为观察组62例和对照组50例。收集患者一般资料,检测患者NGAL水平以及超声检查颈动脉。使用多因素二元Logistic回归分析高血压患者伴发颈动脉粥样硬化的影响因素。利用ROC曲线评估NGAL对高血压患者伴发颈动脉斑块形成的预测能力。结果观察组相较于对照组吸烟和既往有冠心病的比例更高,差异有统计学意义(χ^(2)=5.062、4.303,P<0.05)。观察组的NGAL水平高于对照组(t=4.023,P<0.01)。ROC曲线分析显示NGAL预测高血压病合并颈动脉硬化的曲线下面积为0.843,95%CI=0.644~0.832,最佳临界值为113.20 ng/mL。NGAL水平和吸烟都是高血压病患者发生颈动脉粥样硬化的影响因素[OR(95%CI)=4.662(1.933~11.252)、3.873(1.312~1.548),P<0.05]。在校正吸烟后,NGAL仍然是高血压病患者发生颈动脉粥样硬化的独立影响因素[OR(95%CI)=7.443(2.993~18.509),P<0.01]。NGAL水平分组越高,颈动脉斑块越不稳定(χ^(2)=17.887,P<0.01)。结论血清NGAL水平是高血压病患者合并颈动脉粥样硬化的影响因素。NGAL的检测对高血压病合并颈动脉粥样硬化的早期筛查、确诊以及治疗有重要的应用价值和临床意义。

Objective To investigate the diagnostic value of serum neutrophil gelatinase associated lipocalin(NGAL)in carotid atherosclerosis and carotid plaque in patients with hypertension.Methods 112 patients with hypertension who underwent physical examination in Jiangsu Shengze Hospital from October 9,2017 to August 17,2018 were selected,and divided into observation group(62 cases)and control group(50 cases)according to the presence or absence of carotid atherosclerosis.The general data of patients was collected,the level of NGAL was detected,and ultrasonography of carotid artery was underwent.Multivariate binary logistic regression was used to analyze the influencing factors of carotid atherosclerosis in patients with hypertension.ROC curve was used to evaluate the predictive ability of NGAL on carotid plaque formation in patients with hypertension.Results The proportions of smoking and previous coronary heart disease in the observation group were higher than those in the control group(χ^(2)=5.062,4.303;P<0.05).The level of NGAL in the observation group was higher than that in the control group(t=4.023,P<0.001).ROC curve analysis showed that the area under the curve of NGAL was 0.843(95%CI=0.644-0.832),the optimal cut-off value was 113.20 ng/mL.NGAL level and smoking were the influencing factors of carotid atherosclerosis in patients with hypertension[OR(95%CI)=4.662(1.933-11.252),3.873(1.312-11.548);P<0.05].After adjusting smoking,NGAL was still an independent influencing factor of carotid atherosclerosis in patients with hypertension[OR(95%CI)=7.443(2.993-18.509);P<0.01].The higher the NGAL level was,the more unstable the carotid plaque was(χ^(2)=17.887,P<0.01).Conclusion Serum NGAL level is an influencing factor of hypertension complicated with carotid atherosclerosis.The detection of NGAL has important application value and clinical significance for the early screening,diagnosis and treatment of hypertension complicated with carotid atherosclerosis.