尿中性粒细胞明胶酶相关脂质运载蛋白、肝型脂肪酸结合蛋白对成人泌尿系统疾病致急性肾损伤诊断价值及检测临床意义

Diagnostic value and clinical significance of urinary NGAL and L-FABP in adult patients with acute kidney injury caused by urinary system diseases

目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)对成人泌尿系统疾病致急性肾损伤(AKI)的诊断价值及检测临床意义。方法:选取115例泌尿系统疾病患者为研究对象。根据是否发生AKI分为AKI组48例、非AKI组67例。比较AKI组和非AKI组患者一般资料,测定血清肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)、血红蛋白(Hb)及尿NGAL、L-FABP水平。采用Logistic回归模型分析泌尿系统疾病患者发生AKI的危险因素,Spearman相关分析AKI组尿NGAL、L-FABP与Scr的相关性,ROC曲线评估尿NGAL和L-FABP水平对AKI的诊断价值。结果:AKI组APACHEⅡ评分、尿L-FABP、NGLA及血清Scr、BUN水平高于非AKI组,eGFR水平低于非AKI组(均P<0.05)。Logistic多因素回归分析显示eGFR和血清Scr、BUN及尿NGAL、L-FABP水平均为泌尿系统疾病患者发生AKI的独立危险因素(均P<0.05)。尿NGAL、L-FABP水平与Scr呈正相关(r=0.609、0.817,均P<0.001)。尿NGAL、L-FABP联合检测对泌尿系统疾病患者发生AKI的诊断效能优于单独检测,尿NGAL诊断AKI的曲线下面积为0.803,灵敏度79.17%,特异度70.83%。尿L-FABP的曲线下面积为0.817,灵敏度为81.25%,特异度66.67%,联合检测曲线下面积为0.887,灵敏度87.50%,特异度77.08%(P<0.001)。结论:泌尿系统疾病所致AKI患者尿液中L-FABP、NGAL指标水平上升,尿NGAL、L-FABP联合检测更有利于诊断AKI。

Objective:To investigate the diagnostic value and clinical significance of urinary neutrophil gelatinase related lipid transporter(NGAL)and hepatic fatty acid binding protein(L-FABP)in adult patients with acute kidney injury(AKI)caused by urinary system diseases.Methods:A total of 115 patients with urinary system diseases were selected as the study subjects.According to the presence or absence of AKI,the patients were divided into AKI group(48 cases)and non-AKI group(67 cases).The general data of patients in AKI group and non-AKI group were compared,and serum creatinine(Scr),blood urea nitrogen(BUN),albumin(Alb),hemoglobin(Hb),urinary NGAL and L-FABP levels were measured.Logistic regression model was used to analyze the risk factors of AKI in patients with urinary system diseases.Spearman correlation analysis was used to analyze the correlation between urinary NGAL,L-FABP and Scr in AKI group.ROC curve was used to evaluate the diagnostic value of urinary NGAL and L-FABP levels for AKI.Results:The APACHEⅡscore,urinary L-FABP,and serum Scr and BUN levels in the AKI group were higher than those in the non-AKI group,and the urinary NGAL and serum Scr and BUN levels in the AKI group were lower than those in the non-AKI group(all P<0.05).Logistic regression analysis showed that eGFR,serum Scr,BUN,and urine NGAL,L-FABP levels were independent risk factors for AKI in patients with urinary system diseases(all P<0.05).The levels of NGAL and L-FABP in urine were positively correlated with Scr(r=0.609,0.817,both P<0.001).The combined detection of urinary NGAL and L-FABP was superior to the single detection in the diagnosis of AKI in patients with urinary system diseases.The area under the curve of urinary NGAL in the diagnosis of AKI was 0.803,the sensitivity was 79.17%,and the specificity was 70.83%;the area under the urine L-FABP curve was 0.817,with a sensitivity of 81.25%and specificity of 66.67%;the area under the combined detection curve was 0.887,with a sensitivity of 87.50%and specificity of 77.08%(P<0.001).Conclusion:The levels of L-FABP and NGAL in urine of AKI patients caused by urinary system diseases increase.The combined detection of urinary NGAL and L-FABP is more conducive to the diagnosis of AKI.