中性粒细胞明胶酶相关脂质运载蛋白在诊断肾性贫血及评估病情中的应用价值

Application value of neutrophil gelatinase-associated lipocalin in diagnosing renal anemia and evaluating condition of disease

目的探讨血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在诊断肾性贫血及评估病情中的应用价值。方法选取慢性肾脏病(CKD)合并贫血患者86例为研究对象,根据贫血程度分为轻症组[血红蛋白(Hb)≥90 g/L]54例和中重症组(Hb<90 g/L)32例。另选取同期CKD未合并贫血患者36例作为对照组。比较各组患者红细胞(RBC)、红细胞压积(HCT)、Hb、血NGAL、血肌酐(Scr)和血尿素氮(BUN)水平;分析血NGAL与各项指标的相关性;采用受试者工作特征(ROC)曲线分析血NGAL诊断肾性贫血的价值。结果中重症组血NGAL、Scr、BUN水平高于轻症组和对照组,轻症组血NGAL、Scr、BUN水平高于对照组,差异均有统计学意义(P<0.05)。Spearman相关分析显示,CKD合并贫血患者的血NGAL与RBC、HCT和Hb呈显著负相关(P<0.05),与Scr和BUN呈显著正相关(P<0.05)。ROC曲线分析结果显示,血NGAL水平诊断肾性贫血的曲线下面积(AUC)为0.729,灵敏度为80.2%(95%CI:70.6~87.3),特异度为61.1%(95%CI:44.9~75.2),最佳临界值为134.62 ng/mL。结论血NGAL水平与肾性贫血病情程度密切相关,动态监测血NGAL水平可为肾性贫血患者的临床诊断和病情评估提供参考依据。

Objective To explore the application value of blood neutrophil gelatinase-associated lipocalin(NGAL)in diagnosing renal anemia and evaluating condition of disease.Methods A total of 86 patients with chronic kidney disease(CKD)complicated with anemia were selected as research objects,and they were divided into mild group[hemoglobin(Hb)≥90 g/L]with 54 cases and moderate to severe group(Hb<90 g/L)with 32 cases according to the degree of anemia.Another 36 CKD patients without anemia in the same period were selected as control group.The levels of red blood cell(RBC),hematocrit(HCT),Hb,blood NGAL,serum creatinine(Scr)and blood urea nitrogen(BUN)were compared among groups;the correlations between blood NGAL and various indexes were analyzed;the value of NGAL in diagnosis of renal anemia was analyzed by receiver operating characteristic(ROC)curve.Results The levels of blood NGAL,Scr and BUN in the moderate to severe group were significantly higher than those in the mild group and the control group,and the levels of blood NGAL,Scr and BUN in the mild group were significantly higher than those in the control group(P<0.05).Spearman correlation analysis showed that blood NGAL in CKD patients complicated with anemia was significantly negatively correlated with RBC,HCT and Hb(P<0.05),and positively correlated with Scr and BUN(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of blood NGAL level in the diagnosis of renal anemia was 0.729,the sensitivity was 80.2%(95%CI,70.6 to 87.3),the specificity was 61.1%(95%CI,44.9 to 75.2),and the optimal cut-off value was 134.62ng/m L.Conclusion The level of blood NGAL is closely related to the severity of renal anemia,and dynamic monitoring of blood NGAL level can provide reference for clinical diagnosis and disease evaluation of patients with renal anemia.