血NGAL水平在ICU急性肾损伤患者早期CRRT中的作用研究

Clinical study on roles of serum NGAL levels in early CRRT for patients with acute kidney injury in ICU

目的探讨血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平在ICU急性肾损伤(AKI)患者早期连续性肾脏替代治疗(CRRT)中的作用。方法选取2019年1至12月在浙江省台州医院ICU诊断为AKI并接受CRRT的112例患者为研究对象。在诊断AKI时检测患者血NGAL水平,同时收集患者一般临床资料、实验室指标等。根据患者入ICU诊断AKI后24 h内是否行CRRT分为早期CRRT组59例和延迟CRRT组53例,采用Kaplan-Meier法评价早期CRRT对AKI患者28 d生存预后的影响。根据血NGAL水平,将患者分为NGAL高表达组(≥228.79 ng/mL)及NGAL低表达组(<228.79 ng/mL),采用Kaplan-Meier法评价不同血NGAL水平组内早期CRRT与延迟CRRT患者28 d生存预后。结果早期CRRT组患者28 d全因死亡率低于延迟CRRT组,生存时间长于延迟CRRT组,差异均有统计学意义(均P<0.01)。NGAL低表达组内早期CRRT与延迟CRRT患者28 d全因死亡率及生存时间比较差异均无统计学意义(均P>0.05)。NGAL高表达组内早期CRRT患者28 d全因死亡率低于延迟CRRT患者,而生存时间长于延迟CRRT患者,差异均有统计学意义(均P<0.01)。结论ICU中AKI患者早期行CRRT预后更好,血NGAL水平≥228.79 ng/mL可以作为ICU中AKI患者行早期CRRT的参考指标。

Objective To assess the role of serum neutrophil gelatinase associated lipocalin(NGAL)levels in early continuous renal replacement treatment(CRRT)for patients with acute kidney injury(AKI)in intensive care unit(ICU).Methods A total of 112 patients diagnosed with AKI and treated with CRRT were selected from the ICU of Taizhou Hospital of Zhejiang Province from January 2019 to December 2019.During the diagnosis of AKI,the blood NGAL level of patients was detected,and the general clinical data and laboratory indicators of patients were collected.Patients were divided into early CRRT group(59 cases)and delayed CRRT group(53 cases)according to whether they received CRRT within 24 h after diagnosis of AKI in ICU.Kaplan-Meier method was used to evaluate the effect of early CRRT treatment on 28-day survival prognosis of patients with AKI.According to the level of NGAL expression,the patients were divided into high NGAL expression group(≥228.79 ng/mL)and low NGAL expression group(<228.79 ng/mL).Kaplan-Meier method was used to evaluate the 28-day survival prognosis of patients with early CRRT and delayed CRRT in groups with different NGAL expression levels.Results The 28-day all-cause mortality in the early CRRT group was lower than that in the delayed CRRT group,and the survival time was longer than that in the delayed CRRT group,with statistical significance(all P<0.01).In the low NGAL expression group,there were no significant differences in 28-day all-cause mortality and survival time between early CRRT group and delayed CRRT group(all P>0.05).In the high NGAL expression group,the 28-day all-cause mortality of patients with early CRRT was lower than that of those received delayed CRRT,and the survival time was higher than that of patients received delayed CRRT,with statistical significance(all P<0.01).Conclusion AKI patients in ICU who receive early CRRT treatment have a better prognosis,and blood NGAL concentration≥228.79 ng/mL can be used as a reference index for AKI patients in ICU to receive early CRRT.