急性肾损伤患者中性粒细胞明胶酶相关脂质运载蛋白动态变化及意义

Dynamic changes and significance of neutrophil gelatinase-associated lipocalin in patients with acute kidney injury

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)浓度在急性肾损伤患者中的动态变化及其临床应用价值。方法本研究纳入2016年—2020年12月本院急性肾损伤(AKI)确诊患者51例,根据KDIGO诊断标准,本研究将患者确诊AKI时刻定为“0”时,并以此时作为基时,以12 h作为间距,收集每位患者确诊前后,即-48 h、-36 h、-24 h、-12 h、0 h(“0”时)、12 h、24 h,这7个时间点的标本,检测NGAL、血清肌酐(SCr)。结果AKI患者的SCr与NGAL两者之间存在正相关性;AKI患者确诊之前,SCr变化不大,而血清NGAL在-24 h即显著升高,于“0 h”达到峰值,2组比较,差异有统计学意义;以ROC曲线下面积(AUC)评价不同时间段NGAL、SCr的诊断性能,其中-24 h NGAL、-12 h NGAL、0 h NGAL与0 h SCr的AUC皆>0.9。-24 h NGAL诊断效能最佳,对应NGAL值为159.2 ng/ml。结论AKI患者中,血清NGAL比SCr早升高24 h~36 h,当NGAL浓度>159.2 ng/ml时,有利于临床早期诊断AKI,及时用药治疗。

Objective To investigate the dynamic changes of serum neutrophil gelatinase-associated lipocalin(NGAL)concentration in patients with acute kidney injury and its clinical application value.Methods Fifty one patients diagnosed as acute kidney injury(AKI)were enrolled into this study from our hospital during December 2016-December 2020.According to the KDIGO diagnostic criteria,the study set the moment of diagnosis as AKI as"0".And based on this time,with 12 hours as the interval,before and after the diagnosis,namely-48 h,-36 h,-24 h,-12 h,0 h("0"),12 h,and 24 h,each patient’s serum samples were collected at that seven time points.The serum NGAL and serum creatinine(SCr)of patients with AKI were detected.Results There was a positive correlation between SCr and NGAL in AKI patients;Before AKI patients were diagnosed,the concentration of SCr didn’t change much,while serum NGAL increased significantly at-24 h,and reached a peak at“0 h”.Comparison between the two groups was conducted and the difference was statistically significant;The area under the ROC curve(AUC)was used to evaluate the diagnostic performance of NGAL and SCr in different time periods,and the AUC of-24 h NGAL,-12 h NGAL,0 h NGAL and 0 h SCr were all greater than 0.9.Moreover,-24 h NGAL has the best diagnostic performance,and the corresponding NGAL value was 159.2 ng/ml.Conclusion In patients with AKI,serum NGAL rises 24 h-36 h earlier than SCr.When the concentration of NGAL is greater than 159.2 ng/ml,it is helpful for the early clinical diagnosis of AKI and needs timely medication.