The Differences of Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels between Asphyxiated and Non-Asphyxiated Neonates

Objective: To evaluate the differences of urinary NGAL levels between asphyxiated and non-as- phyxiated neonates. Methods: This was a cross-sectional observational analytic study, including 34 newborns in Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Sample collection was conducted from December 2014 to March 2015. Urine NGAL levels were evaluated using enzyme-linked immunosorbent assays (ELISA) technique. To determine the differences of urinary NGAL levels between asphyxiated and non-asphyxiated group we used Mann-Whitney U test, and to determine the differences of gestational age and birth weight between these two groups we used Fisher’s exact test. Results: Twenty males (60%) and 14 females (40%) neonates participated in the study. From 34 subjects, 17 neonates were diagnosed with asphyxia and 17 neonates without asphyxia. The results showed that urine NGAL levels had significantly increased in asphyxiated neonates. The median urine NGAL level in asphyxiated group is 95% CI: 506.7 (60.0 - 651.7) ng/mL, while the median urine NGAL level in non-asphyxiated group is 95% CI: 6.7 (0.1 - 53.0) ng/mL. Statistically, there were significant urine NGAL levels differences between asphyxiated and non-asphyxi- ated neonates (p < 0.001). There were no differences in gestational age and birth weight between asphyxiated and non-asphyxiated neonates (p > 0.05). Conclusions: Urinary NGAL levels in asphyxiated neonates were significantly higher than those in non-asphyxiated neonates. There were significant differences of urine NGAL levels between the groups.

Evaluation of Reticulocyte Hemoglobin Content and Serum Neutrophil Gelatinase-Associated Lipocalin as Predictive Biomarkers of Anemia in Children on Hemodialysis

Background: Diagnosis of iron deficiency anemia with currently available tests is rendered difficult in hemodialysis patients. The aim: To investigate the role of reticulocyte Hemoglobin Content (CHr) in the diagnosis of iron deficiency anemia in hemodialysis children in comparison to the used traditional markers and assess the impressiveness and the utility of Neutrophil Gelatinase Associated Lipocalin (NGAL) as a novel biomarker of iron status in those patients. Methods: This study investigated CHr in addition to NGAL serum level in the same line with traditional markers for anemia, including: CBC, serum iron, ferritin, total iron-binding capacity (TIBC), and transferrin saturation (TSAT%). Results: It is more significant that CHr content in hemodialysis children is lower than their controls as they are (27.06 ± 2.90) pg and (32.86 ± 3.59) pg, respectively, p = 0.01. There is no significant difference regarding NGAL between the study groups. Significant negative correlation between CHr with ferritin, urea, creatinine, and positively correlated with iron and RBCS. CHr showed a sensitivity of 90% and specificity of 86.67% to detect iron-deficiency anemia with a cut-off value of 27 pg. Conclusion: CHr is superior to ferritin and TSAT % for the early diagnosis of iron deficiency anemia in hemodialysis children;our results do not support NGAL as a marker of anemia in hemodialysis patients.

Urinary Neutrophil Gelatinase Associated Lipocalin as a Marker of Tubular Damage in Type 2 Diabetic Patients with and without Albuminuria

Background: Neuttrophil gelatinase associated lipocalin (NGAL) was shown to be a good marker for predicting acute kidney injury (AKI). Some recent reports demonstrated that NGAL may be an early biomarker for kidney affection in diabetic patients. The aim of this work is to investigate urinary NGAL (UNGAL) in type 2 diabetic patients with and without albuminuria. Methods: This study included 46 type 2 diabetic patients and 15 healthy age and sex matched individuals as the control group. Diabetic patients were divided into three groups according to urinary albumin excretion (UAE), normoalbuminuria, microalbuminuria and macroalbuminuria. UNGAL was measured in all populations and corrected to urinary creatinine to account for day to day variation in urine volume and transformed log. Comparison between 4 groups (control, normoalbuminuria, microalbuminuria and macroalbuminuria) was done. Results: Log UNGAL/Creatinine ratio showed significant difference when comparing control group (0.70 ± 0.58) versus normoalbuminuria (1.71 ± 1.06), microalbuminuria (1.57 ± 0.72) and macroalbuminuria (1.92 ± 0.63), however, there was no significant difference among diabetic groups. Pearson’s correlation showed that log UNGAL/Creatinine ratio positively correlated with glycated hemoglobin (HbA1c) and inversely with estimated glomerular filtration rate (eGFR). Regression analysis showed that HbA1c, urinary creatinine and eGFR were the independent predictors of log UNGAL/Creatinine ratio. Conclusion: Tubular markers like UNGAL may be early elevated in type 2 diabetic patients even before the incidence of glomerular injury detected by microalbuminuria and it can be used as an early marker for detection of kidney involvement in diabetic patients.

Is neutrophil gelatinase associated lipocalin useful in hepatitis C virus infection?

AIM: To evaluate neutrophil gelatinase associated lipocalin(NGAL) in patients infected by hepatitis C virus(HCV) before and during treatment with directly acting antivirals(DAAs).METHODS: NGAL was measured in a group of patients with chronic HCV infection ranked, at baseline, by age, gender, anti-hypertensive therapy, HCV viral load, liver fibrosis stage and, either at baseline or after 1 year, estimated glomerular filtration rate(e GFR). Then, NGAL and e GFR evolutions were monitored in a subgroup of patients who started antiviral therapy with DAAs. Differences of median NGAL levels were evaluated through Wilcoxon-Mann-Whitney test for nonparametric data. Differences in dichotomous variables were evaluated through χ~2 test. At baseline, a univariate regression analysis was conducted to verify if NGAL values correlated with other quantitative variables [age, fibrosis four(FIB-4), AST to platelet ratio index(APRI), and e GFR]. RESULTS: Overall, 48 patients were enrolled, 8 of them starting HCV treatment. At baseline, statistically significant differences were found in median NGAL values only between patients with e GFR < 60 mL/min vs patients with e GFR ≥ 90 mL/min. Differences in NGAL were not significant among patients ranked by HCV viral load, FIB-4 score and APRI, when patients with NGAL > 118.11 ng/d L were compared with those of NGAL ≤ 118.11 ng/d L, not statistically significant differences were present for age, gender, chronic kidney disease classification and liver fibrosis(P > 0.05). Linear correlation was found between NGAL and both age(P = 0.0475) and e GFR(P = 0.0282) values. Not statistically significant predictions of NGAL at baseline were demonstrated for e GFR evolution 1 year later. Interestingly, in the 8 patients treated with DAAs, median NGAL significantly increased at week 12 compared to baseline(P = 0.0239).CONCLUSION: Our results suggest that NGAL should be further evaluated as an adjunct marker of kidney function in these patients.

Levels of neutrophil gelatinase-assosciated lipocalin in patients with head and neck squamous cell carcinoma in Indian population from Haryana state

AIM To study the levels of neutrophil gelatinase associated lipocalin(NGAL) in head and neck squamous cell carcinoma(HNSCC).METHODS This was a non randomized case control study conducted at Department of Biochemistry,in collaboration with Regional Cancer Center over a period of one year.The study population included 50 adult newly diagnosed HNSCC patients reporting in outpatient department at Regional Cancer Center and compared with 50 healthy controls.NGAL was estimated by ELISA technique.Student t test and χ~2 test were applied for comparison of means of study groups.Correlations between groups were analyzed using Pearson correlation coefficient(r) formula.RESULTS Patients with HNSCC exhibited significantly increased levels of NGAL(P < 0.05) as compared to healthy controls(978.88 ± 261.39 ng/mL vs 34.83 ± 7.59 ng/mL).Out of 50,26 patients(52%) were in stage Ⅳ,21(42%) in stage Ⅲ,1(2%) patient in stage Ⅱ and 2(4%) patients were in stage Ⅰ.Metastasis was absent in 98% patients and mean NGAL levels were highest in these patients but P value was not significant.Mean NGAL levels were highest in stage Ⅳ [1041.54 ± 222.15 ng/mL(stage Ⅳ) vs 1040 ± 0.00 ng/mL(stage Ⅰ);900 ± 0.00 ng/mL(stage Ⅱ) and 1031.90 ± 202.55 ng/mL(stage Ⅲ)] and χ~2 test was highly significant(P < 0.001).Thirty-six patients(72%) were having moderately differentiated HNSCC and mean NGAL levels were maximum in patients with well differentiated HNSCC(1164 ± 315.64 ng/mL vs 1013.33 ± 161.19 ng/mL in moderately differentiated and 890 ± 11.55 ng/mL in poorly differentiated) and the results were also highly significant(P < 0.001,χ~2 test).CONCLUSION The present work demonstrates a potential role of NGAL as cancer biomarker and its use in monitoring the HNSCC progression.

Study of Lipocalin-2 Associated with Neutrophilic Gelatinases (uNGAL) in the Urine in Children with the Microbial Inflammatory Diseases of Kidneys and Urinary Tract

Purpose of the study: Research of the clinical and diagnostic significance of determination of Lipocalin-2 associated with neutrophilic gelatinases (uNGAL) in the urine of children with urinary tract infection (UTI) and pyelonephritis. Materials and methods: We examined 30 children with acute pyelonephritis and UTI aged 1 to 16 years (average age 7.32 ± 4.52) including 26 girls and 4 boys. Verification of the diagnosis was conducted on the basis of clinical and laboratory data, medical history and instrumental examination of patients. All children were divided into 2 groups: 1st group—15 children with acute pyelonephritis, 2nd group—15 children with urinary tract infection. uNGAL was measured in the urine by enzyme-linked immunosorbent assay (EISA) (BioVendor Laboratoty Medicine). Results: It is found, that the urine level of NGAL depends on the damage degree of renal parenchyma. The correlation of medium strength was found between the excretion level of uNGAL during the acute period of pyelonephritis and the detection of renal scars according to the DMSA-nephroscintigraphy data. In the group of children with the acute pyelonephritis the direct correlation of medium strength was found between the excretion level of uNGAL/creatinine and leukocytosis value and also with the CRP blood level. Conclusion: The results allow us to recommend the determination of the excretion level of uNGAL/creatinine as an additional non-invasive marker for the early detection of renal parenchyma injury.

Correlation between Serum Neutrophil Gelatinase Associated Lipocalin and Burn Severity: A Pilot Study

The severity of an initial burn injury is critical for determining the treatment plan and prognosis of burn patients. Here, we measured serum neutrophil gelatinase-associated lipocalin (NGAL) levels to determine whether NGAL can be used as a biomarker for severity of burn injuries. A study of the demographic, clinical, and laboratory markers for various organ damage was performed at Bestian Burn Center (n = 10 healthy people, n = 31 patients). NGAL and organ damage marker levels were measured in 31 patients with severe burns within 2 - 3 days following their admission to the intensive care unit. Serum NGAL level of the expired patients was 788.5 (685.0 - 998.0) pg/mL, whereas that of the discharged patients was 421.2 (356.2 - 480.6) pg/mL, showing that the initial serum NGAL level can be used to estimate mortality. We also determined the correlation between serum NGAL level and the currently used severity markers (total body surface area burned and abbreviated burn severity index) and confirmed that serum NGAL level could be used as a severity marker. We also found that serum NGAL level was correlated with damage of organs such as the liver, kidney, heart, and respiratory organs in patients with severe burns.

Plasma neutrophil-gelatinase-associated lipocalin and cystatin C could early diagnose contrast-induced acute kidney injury in patients with renal insufficiency undergoing an elective percutaneous coronary intervention

Background Contrast induced acute kidney injury （CIAKI） is an important complication in the use of iodinated contrast media （CM）. Our study was to evaluate the neutrophil gelatinase-associated lipocalin （NGAL） and cystatin C for early diagnosis of CIAKI. Methods The patients with established or suspected coronary artery disease （CAD） with the estimated glomerular filtration rate （eGFR） was more than 30 ml·min^-1·1.73 m^-2 and nor more than 90 ml·min^-1·1.73 m^-2 were continuously enrolled. The blood samples of the first 50 patients were obtained before and at 2, 4, 8, 24 and 48 hours after procedure to identify the time points at which the biomarkers reached peaks and at which the blood samples of the rest of patients were obtained. The plasma NGAL and cystatin C measure used enzyme-linked immunosorbent assay （ELISA） kit. The diagnostic characteristics of absolute and relative increasing NGAL and cystatin C for CIAKI were evaluated. Results Total 311 patients were enrolled, among whom 39 （12.5%） developed CIAKI. Plasma NGAL increased at 2 hours and reached peak at 4 hours after procedure, while plasma cystatin C increased at 2 hours and reached peak at 24 hours after procedure. Thus, we determine rational point of time at 4 hours for NGAL and at 24 hours after procedure for cystatin C, respectively. The plasma NGAL at 4 hours after CM exposure showed largest area under curve （AUC） of 0.662 （95% confidence interval （CI）： 0.565-0.758, P=0.002） with 51.5% sensitivity and 80.6% of specificity. The relative increasing 25% of NGAL showed the best sensitivity and specificity of 0.872 and 0.808, respectively, with maximum Youden index of 0.680, while cystatin C with relative increasing more than 25% had 76.9% of sensitivity and 81.2% of specificity. Combined two biomarkers might get more than 90% of specificity. Conclusions Single measurement of NGAL or cystatin C had poor sensitivity and specificity; however, the relative increasing 25% of NGAL at 4 hours after CM exposure demonstrated higher diagnostic values for CIAKI. Combining relative increasing plasma NGAL with relative increasing plasma cystatin C might perform better for early diagnosis of CIAKI.

Effect of Rhizoma Polygoni Cuspidati and Ramulus Cinnamomi Compatibility on Uric Acid Metabolism and Urinary Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 in Rats with Hyperuricemia

Objective：To explore the effects of Rhizoma Polygoni Cuspidati and Ramulus Cinnamomicompatibility（PR） on uric acid metabolism and the expression of urinary neutrophil gelatinase-associated lipocalin（NGAL） and kidney injury molecule-1（KIM-1） in rats with hyperuricemia. Methods：Seventy male Sprague Dawley（SD） rats were randomly divided into 7 groups with 10 rats per group, including the normal group, model group, allopurinol group, benzbromarone group and PR groups at 3 doses（3.5, 7, 14 g/kg）. Except the normal group, rats of the other groups were intragastrically administered 100 mg/kg hypoxanthine and 250 mg/kg ethambutol, and subcutaneously injected with 200 mg/kg potassium oxonate. All rats were continuously modeled for 17 days, and gavaged with corresponding drugs. The rats of the normal and model groups were gavaged with saline, once a day, for 2 weeks. The levels of serum uric acid（SUA）, blood urea nitrogen（BUN） and creatinine（Cr） were determined. In addition, the contents of NGAL and KIM-1 in urine and the m RNA and protein expressions of xanthine oxidase（XOD） in liver of hyperuricemia rats were measured by reverse transcription polymerase chain reaction（RT-PCR） and Western blot, respectively. Moreover, the pathological changes of kidney were analyzed by hematoxylin and eosin（HE） stain method. Results：Compared with the normal group, the levels of SUA, BUN, NGAL and KIM-1 and the expressions of hepatic XOD m RNA and protein in the hyperuricemia rats were increased significantly（P〈0.01）. PR significantly decreased the levels of SUA, BUN, NGAL and KIM-1 and down-regulated the m RNA and protein expressions of hepatic XOD（P〈0.05 or P〈0.01）. In addition, the pathological changes of kidney were significantly suppressed by oral administration of PR. Conclusions：PR ameliorated uric acid metabolism and protected renal function, the underlying mechanism was mediated by decreasing the levels of SUA, BUN, NGAL and KIM-1, inhibiting the expression of hepatic XOD and ameliorating the pathological change of kidney.

Urine neutrophil gelatinase-associated lipocalin at SICU admission predicts for cardiac surgery-associated acute kidney injury

Background Acute Kidney Injury （AKI） is a common and serious complication of cardiovascular surgery. There is a need to find biomarkers that are involved in the etiology of cardiac surgery-associated acute kidney injury （CSA-AKI） and have an earlier response to acute kidney injury. The association between urine neutrophil gelatinase-associated lipocalin （NGAL） concentrations and AKI progression is not well established. Methods The prospective-cohort study included 1631 consecutive adult patients undergoing cardiac surgery at Fuwai Hospital between September 2012 and November 2013. AKI defined by Acute Kidney Injury Network （AKIN） criteria with a postoperative increase in plasma creatinine 〉/50% baseline or/〉0.3 mg/dL. Urine NGAL was measured us- ing latex particle-enhanced turbidimetric immunoassay. Associations between Urine NGAL levels and AKI were determined by estimating areas under receiver operating characteristic curves （AUC）. Results A total of 438 （26.9%） patients developed CSA-AKI. And the patients were divided into four groups： 1193 non-AKI patients, 368（22.6%） patients with AKIN stage I AKI, 49（3.0%） with AKIN stage 2 AKI and 21（1.3%） with AKIN stage 3 AKI. urine NGAL concentrations at surgical intensive care unit （SICU） admission were significantly related to AKI severity. The AUCs for urine NGAL were for AKIN stage 1 （0.54±0.02）, AKIN stage 2 （0.67±0.04）, and AKIN stage 3 （0.76±0.06）, respectively. Conclusions Urinary NGAL is associated with CSA-AKI and its progression, indicating their potential use as prognostic markers. Urine NGAL level measured at SICU admission predicts the development of severe AKI after cardiac surgery.

血清LRG1、NGAL和PGC-1α水平与小儿肾积水手术后分肾功能的相关性研究

目的探究血清富亮氨酸α2-糖蛋白1(leucine-richα2 glycoprotein 1,LRG1)、中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、过氧化物酶体增殖物激活受体γ辅助激活因子-1α(peroxisome proliferator activated receptorγcoactivator-1α,PGC-1α)水平与小儿肾积水术后分肾功能(differential renal function,DRF)的相关性。方法本研究为回顾性研究,选取邯郸市中心医院2019年3月至2022年6月期间行肾盂输尿管成形术的124例肾积水患儿作为研究对象,根据术后18个月DRF情况,将患儿分为DRF≥45%组(n=72)和DRF<45%组(n=52)。采用酶联免疫吸附法检测患儿血清中LRG1、NGAL和PGC-1α水平。采用Pearson相关性分析探讨血清LRG1、NGAL、PGC-1α水平与肾功能的相关性,采用二元Logistic回归分析肾积水患儿术后DRF<45%的影响因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析血清LRG1、NGAL、PGC-1α对肾积水患儿术后DRF的预测价值。结果DRF≥45%组和DRF<45%组患儿血清LRG1分别为(184.28±55.46)ng/mL、(315.62±98.53)ng/mL(t=9.437,P<0.05);肌酐(rerum Creatinine,Scr)分别为(26.84±7.64)μmol/L和(35.46±10.27)μmol/L(t=5.361,P<0.05);尿素氮(blood urea nitrogen,BUN)分别为(5.24±1.52)mmol/L和(7.23±2.31)mmol/L(t=5.783,P<0.05);β_(2)-微球蛋白(β_(2)-microglobulin,β_(2)-MG)分别为(2.16±0.43)mg/L和(3.68±0.84)mg/L(t=13.164,P<0.05);PGC-1α分别为(4.26±1.14)ng/mL和(2.85±0.89)ng/mL(t=7.430,P<0.05);术前患侧DRF分别为(43.25±4.57)%和(31.58±3.68)%(t=15.192,P<0.05);差异均有统计学意义。Pearson相关性分析结果显示,LRG1、NGAL与Scr、BUN、β_(2)-MG呈正相关(P<0.05);PGC-1α与β_(2)-MG、Scr、BUN呈负相关(P<0.05)。Logistic回归分析显示,血清LRG1、NGAL、Scr、BUN、β_(2)-MG、PGC-1α、术前患侧DRF是术后DRF<45%的影响因素(P<0.05)。ROC曲线分析显示,血清LRG1、NGAL、PGC-1α及三者联合评估肾积水患儿术后DRF<45%的曲线下面积(area under the curve,AUC)分别为0.899、0.872、0.878及0.982,三者联合评估优于单独评估(Z_(三者联合-LRG1)=3.148、Z_(三者联合-NGAL)=3.937、Z_(三者联合-PGC-1α)=3.125,P<0.05)。结论肾积水术后DRF<45%的患儿血清中LRG1、NGAL水平升高,PGC-1α水平降低,三者联合检测对于术后DRF具有一定的预测价值。

PTEN、CA125、sVEGFR1、NGAL在子宫内膜癌患者血清中的表达及与病理特征的关系

目的 探讨第10号染色体缺失的磷酸酶及张力蛋白同源基因(PTEN)、糖类抗原125(CA125)、可溶性血管内皮生长因子受体-1(sVEGFR1)、中性粒细胞明胶酶相关脂质载运蛋白(NGAL)在子宫内膜癌(EC)患者血清中的表达及与病理特征的关系。方法 选取2019年1月至2021年6月于在邯郸市第一医院行全子宫切除术并经病理诊断的120例EC患者为研究组,选择同期80例良性病变子宫内膜患者为对照组,用酶联免疫吸附法检测并比较2组患者血清PTEN、CA125、sVEGFR1、NGAL水平,收集2组临床病理资料,分析血清PTEN、CA125、sVEGFR1、NGAL与研究组患者病理特征的关系。结果 研究组血清CA125、NGAL水平高于对照组,血清PTEN、sVEGFR1水平低于对照组(P<0.05)。分化程度越低血清CA125、NGAL水平越高,血清PTEN、sVEGFR1水平越低(P<0.05);临床分期Ⅲ~Ⅳ期患者血清PTEN高于Ⅰ~Ⅱ期(P<0.05);临床分期Ⅲ~Ⅳ期、有淋巴结转移、浸润深度≥50%患者血清CA125、NGAL水平升高,血清sVEGFR1水平降低(P<0.05)。血清PTEN与临床分期呈负相关,与分化程度呈正相关(P<0.05);血清CA125、NGAL与临床分期、淋巴结转移、浸润深度呈正相关,与分化程度呈负相关(P<0.05);血清sVEGFR1与临床分期、淋巴结转移、浸润深度呈负相关,与分化程度呈正相关(P<0.05)。结论 CA125、NGAL在EC患者血清中呈高表达,PTEN、sVEGFR1呈低表达,均与EC患者病理特征有一定相关性,可作为EC早期诊断与疾病进展的潜在生物学标志物。

血清PTX3 SFRP4联合尿NGAL对糖尿病肾病的诊断价值

目的:探讨联合检测尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及血清正五聚蛋白3(PTX3)和分泌型卷曲相关蛋白4(SFRP4)对临床上糖尿病肾病(DN)的诊断意义。方法:选取我院2020年12月至2023年6月就诊的DN患者86例,作为DN组,根据尿微量白蛋白排泄率(UAER)分为早期组(24例,UAER≤20μg/min)、中期组(30例,20μg/min<UAER<200μg/min)、晚期组(32例,UAER≥200μg/min),根据病情严重程度分为轻度DN组(40例)和中重度DN组(46例),另选取40例单纯2型糖尿病患者为对照组。比较DN组与对照组、不同病情程度组以及早中晚期组血清PTX3、SFRP4和尿液NGAL水平。分析三者及其联合检测在诊断DN中的临床价值。结果:DN组血清PTX3、SFRP4和尿液中NGAL的水平均高于对照组(P<0.05);与轻度DN组相比中重度DN组患者三个指标的水平也明显升高(P<0.05);中、晚期组DN患者三个指标的水平较早期组升高(P<0.05)。ROC曲线分析显示,三者联合诊断DN的曲线下面积(AUC)为0.985,且联合诊断AUC大于单一指标诊断(Z三者联合-PTX3=2.670、Z三者联合-SFRP4=3.976、Z三者联合-NGAL=2.510,P=0.008、0.000、0.012),敏感度为94.20%,特异性为96.00%。结论:血清PTX3、SFRP4和尿液NGAL联合检测在诊断DN以及评估DN患者严重程度具有更高的可靠性。

中性粒细胞明胶酶相关脂质运载蛋白和生长分化因子15在高血压肾损伤中的诊断价值

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、生长分化因子15(GDF-15)联合检测在老年H型高血压患者肾损伤中的诊断价值。方法选取2021年4月至2022年6月承德医学院附属医院神经内科及全科医疗科收治的H型高血压患者177例,依据估算肾小球滤过率分为肾功能损伤组81例和肾功能正常组96例。收集2组患者一般资料、实验室检查指标,受试者工作特征曲线(ROC)分析血清NGAL、GDF-15联合检测对老年H型高血压患者肾损伤的诊断价值,Pearson相关性分析血清NGAL、GDF-15水平与老年H型高血压患者肾损伤的相关性。结果肾功能损伤组收缩压水平高于肾功能正常组[(148.53±14.62)mm Hg(1 mm Hg=0.133 kPa)vs(138.75±13.36)mm Hg,P<0.01],2组舒张压比较差异无统计学意义(P>0.05);肾功能损伤组肌酐、尿素、β_2微球蛋白(β_2-MG)、胱抑素C(Cys C)、尿微量白蛋白(MA)、NGAL及GDF-15水平高于肾功能正常组(P<0.01);ROC曲线分析显示,NGAL、GDF-15联合检测显著高于NGAL、GDF-15单独检测(P<0.01)。Pearson相关性分析显示,血清NGAL、GDF-15水平与肌酐、尿素、β_2-MG、Cys C、MA水平均呈正相关(P<0.01)。结论老年H型高血压患者出现肾损伤后血清NGAL、GDF-15水平升高,血清NGAL、GDF-15联合检测在老年H型高血压患者肾损伤诊断中具有较高的诊断价值。

急、慢性肾损伤患者血清中生物标志物的研究与验证

目的:探讨血清中中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)及其他生物标志物在急、慢性肾损伤患者中的临床应用价值。方法:选取2022年1月~2023年7月在广州市中山大学附属第三医院就诊的急性肾损伤(acute kidney injury,AKI)患者171例及慢性肾脏病(chronic kidney disease,CKD)患者209例。收集各组成员的钾(K)、钠(Na)、氯(Cl)、二氧化碳(CO_(2))、尿素(Urea)和葡萄糖(GLU)数据。选取同时期健康体检者94例作为健康对照组,并用胶乳免疫比浊法检测3组成员血清中的NGAL水平。分析血清NGAL和其他生物标志物在鉴定急性和慢性肾损伤中的诊断有效性。采用多因素logistic回归方程分析影响AKI和CKD患者发生的因素。此外,还构建了受试者工作特征(receiver operating characteristic,ROC)曲线,以评估这些生物标志物在肾损伤患者中的临床意义。结果:通过生物信息学分析,提示NGAL可能是肾损伤的检测标志物。一般资料显示,在AKI组及CKD组中,K、Na、CO_(2)、Urea、GLU和NGAL水平均高于健康对照组(P<0.05)。多因素logistic回归方程分析显示,Na、Urea、GLU和NGAL水平均为AKI或者CKD疾病发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,在AKI组中,Na、Urea、GLU和NGAL的曲线下面积(area under curve,AUC)分别为0.711、0.960、0.793和0.841(P<0.01);在CKD组中,Na、Urea、GLU和NGAL的AUC分别为0.681、0.990、0.703和0.930(P<0.01)。NGAL和Urea联合诊断AKI的灵敏度和特异性分别是81.9%和61.1%,诊断CKD的灵敏度和特异性分别是62.7%和80.0%。结论:血清NGAL可作为急、慢性肾损伤的指标,联合其他生物标志物在急、慢性肾损伤中也有一定的临床应用价值。

尿液中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素-6水平对心脏外科术后患者严重液体超负荷的风险价值

目的分析尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和白细胞介素-6(IL-6)水平对心脏外科术后患者严重液体超负荷(FO)的风险价值。方法选取2020年4月—2023年3月在成都市第三人民医院接受心脏外科手术的患者220例,根据术后24 h FO,将FO≥10%的患者记为A组,将FO<10%的患者记为B组。分析两组一般资料,比较两组术前及术后尿液NGAL和IL-6水平,采用logistic回归模型分析心脏外科术后24 h内患者发生严重FO的危险因素,绘制ROC曲线,分析尿液NGAL、IL-6对患者发生严重FO的风险价值。亚组分析不同原发病对FO的影响。结果A组男性ICU停留时间比例高于B组(P<0.05),术前白蛋白水平及术后当天尿量低于B组(P<0.05),两组体重指数、年龄、病程、手术时间、术中尿量、原发疾病类型、术前左室射血分数、肌酐水平、白细胞计数、血红蛋白水平、机械通气时间、体外循环时间,以及急性肾损伤、左心功能不全、高血压、心力衰竭、糖尿病占比比较无差异(P>0.05);两组术后2 h、术后12 h尿液NGAL和IL-6水平均高于术前(P<0.05),术后12 h尿液NGAL和IL-6水平均高于术后2 h(P<0.05),且A组术前、术后2 h及术后12 h均高于B组(P<0.05);logistic回归分析发现,术前尿液NGAL和IL-6水平高是心脏外科术后患者发生严重FO的危险因素(P<0.05);ROC结果显示,术前尿液NGAL和IL-6水平对心脏外科术后患者发生严重FO的最佳截断点分别为48.04 ng/mL和32.26 pg/mL,AUC分别为0.865和0.704,二者联合检测AUC为0.894。冠心病、先天性心脏病、心脏瓣膜病亚组之间FO情况、ICU停留时间、体外循环时间、术后当天尿量及术前NGAL和IL-6之间无显著差异(P均>0.05)。结论心脏外科术后患者尿液NGAL和IL-6水平异常升高,术前尿液NGAL和IL-6水平是其发生严重FO的危险因素。

血清NGAL水平联合APACHEⅡ评分对重症肺炎并发急性肾损伤患者预后的预测价值

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平联合急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分对重症肺炎并发急性肾损伤(AKI)患者预后的预测价值。方法选取161例重症肺炎并发AKI患者作为AKI组,80例单纯重症肺炎患者作为非AKI组,再根据AKI组患者入院30 d的预后情况将其分为死亡组(n=54)和存活组(n=107)。比较AKI组和非AKI组患者的血清NGAL水平和APACHEⅡ评分。比较死亡组和存活组患者的临床资料,采用多因素Logistic回归模型分析重症肺炎并发AKI患者预后的影响因素,绘制受试者工作特征(ROC)曲线评估血清NGAL水平联合APACHEⅡ评分对重症肺炎并发AKI患者预后的预测价值。结果与非AKI组比较,AKI组患者血清NGAL水平和APACHEⅡ评分升高(P<0.05)。年龄增长、AKI分期2~3期、血清NGAL水平升高和APACHEⅡ评分升高为重症肺炎并发AKI患者死亡的独立危险因素(P<0.05)。ROC曲线分析结果显示,血清NGAL水平联合APACHEⅡ评分预测重症肺炎并发AKI患者预后的曲线下面积为0.873,大于血清NGAL水平和APACHEⅡ评分单独预测的曲线下面积(P<0.05)。结论重症肺炎并发AKI患者血清NGAL水平和APACHEⅡ评分升高与预后不良密切相关,血清NGAL水平联合APACHEⅡ评分对重症肺炎并发AKI患者预后具有较高的预测效能。

尿MAU联合血清NGAL、IL-27在糖尿病肾病诊断中的应用价值

目的 探讨尿微量清蛋白(MAU)联合血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、白细胞介素-27(IL-27)在糖尿病肾病(DN)诊断中的应用价值。方法 选取2021年2月至2022年3月该院收治的50例糖尿病(DM)患者为DM组,选择同期收治的55例DN患者为DN组,同时选取同期在该院体检的年龄匹配的体检健康者60例作为对照组。检测各组研究对象血清NGAL、IL-27、血红蛋白、清蛋白、胱抑素C水平及尿MAU、尿肌酐、24 h尿蛋白定量。采用Pearson相关分析DN患者血清NGAL、IL-27水平与尿MAU水平、24 h尿蛋白定量的相关性;采用受试者工作特征(ROC)曲线分析尿MAU、血清NGAL、血清IL-27单独及联合检测对DN的诊断价值。结果 DM组、DN组血清胱抑素C、尿肌酐、尿MAU、血清NGAL、血清IL-27水平及尿MAU/尿肌酐比值、24 h尿蛋白定量均显著高于对照组,且DN组显著高于DM组,差异均有统计学意义(P<0.05)。DM组、DN组血清清蛋白、血红蛋白水平显著低于对照组,且DN组显著低于DM组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,DN患者血清NGAL、IL-27水平与尿MAU水平、24 h尿蛋白定量均呈正相关(P<0.05)。ROC曲线分析结果显示,尿MAU、血清NGAL、IL-27诊断DN的曲线下面积(AUC)分别为0.837、0.842、0.847,三者联合诊断DN的AUC为0.940,高于尿MAU、血清NGAL、IL-27单独诊断DN的AUC(Z=2.127、2.091、2.017,P=0.033、0.037、0.044)。结论 DN患者尿MAU、血清NGAL及IL-27水平均较高,且尿MAU联合血清NGAL、IL-27诊断DN的价值高于各指标单独检测,三者联合检测可在一定程度减少漏诊率,为DN患者的诊断提供参考价值,缩短DN患者康复进程。

冠心病患者经皮冠状动脉介入术相关造影剂急性肾损害的影响因素分析及KIM-1、NGAL、NHE3的预测价值

目的探究冠状动脉粥样硬化性心脏病(以下简称冠心病)患者经皮冠状动脉介入术(PCI)相关造影剂急性肾损害(CIAKI)的影响因素,并分析尿液中肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质结合蛋白(NGAL)、钠/氢交换蛋白3(NHE3)预测CIAKI发生的价值。方法回顾性分析2021年7月—2022年6月在齐齐哈尔医学院附属第一医院行PCI的142例冠心病患者的病历资料,根据患者术后是否发生CIAKI,分为CIAKI组和非CIAKI组。分析影响PCI术后发生CIAKI的因素,评估PCI前后KIM-1差值、NGAL差值及NHE3差值对PCI术后发生CIAKI的预测价值。结果142例行PCI的冠心病患者中发生CIAKI 25例(17.61%)。CIAKI组糖尿病占比及造影剂使用剂量高于非CIAKI组(P<0.05),术前GFR水平低于非CIAKI组(P<0.05)。CIAKI组手术前后尿KIM-1、NGAL及NHE3的差值均高于非CIAKI组(P<0.05)。多因素逐步Logistic回归分析结果显示:糖尿病[OR=3.350(95%CI:1.145,9.802)]、造影剂使用剂量[OR=3.377(95%CI:1.154,9.880)]、KIM-1差值[OR=4.958(95%CI:1.695,14.506)]、NGAL差值[OR=4.446(95%CI:1.519,13.008)]、NHE3差值[OR=4.446(95%CI:1.519,3.008)]是冠心病患者PCI术后发生CIAKI的危险因素(P<0.05);GFR[OR=0.262(95%CI:0.089,0.765)]是冠心病患者PCI术后发生CIAKI的保护因素(P<0.05)。受试者工作特征曲线分析结果表明,KIM-1差值、NGAL差值、NHE3差值单一及联合预测冠心病患者PCI术后发生CIAKI的敏感性为75.32%(95%CI:0.594,0.831)、68.59%(95%CI:0.537,0.762)、62.77%(95%CI:0.514,0.735)、80.93%(95%CI:0.629,0.924),特异性为74.01%(95%CI:0.583,0.826)、83.16%(95%CI:0.652,0.941)、78.92%(95%CI:0.603,0.875)、81.15%(95%CI:0.638,0.945),曲线下面积为0.743、0.748、0.762和0.837,联合诊断效能最高。结论糖尿病、GFR、造影剂使用剂量和PCI前后KIM-1、NGAL、NHE3的变化影响CIAKI的发生,PCI前后KIM-1差值、NGAL差值及NHE3差值联合预测CIAKI的效能较好。

高血压脑出血患者早期肾损伤的危险因素研究

目的 探讨高血压脑出血(HICH)患者早期肾损伤(AKI)的危险因素。方法 选取2020年7月至2022年6月江苏省海安市人民医院收治的90例HICH患者作为研究对象,根据患者早期是否发生AKI情况分为AKI组(21例)与非AKI组(69例)。采用单因素及多因素Logistic回归分析评价尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿微量白蛋白与肌酐比值(ACR)及血清同型半胱氨酸(Hcy)是否为影响HICH患者早期AKI发生的独立危险因素,采用受试者操作特征(ROC)曲线评价尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生的预测价值。结果 AKI组输血或使用甘露醇占比及尿NGAL、尿ACR和血清Hcy水平高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,输血或使用甘露醇[OR=3.556,95%CI(1.608~7.864)]、尿NGAL[OR=1.005,95%CI(1.002~1.008)]、尿ACR[OR=1.812,95%CI(1.251~2.625)]及血清Hcy[OR=1.923,95%CI(1.455~2.542)]是影响HICH患者早期AKI发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生均有预测效能(P<0.05),其曲线下面积分别为0.786[95%CI(0.680~0.892)]、0.676[95%CI(0.553~0.799)]和0.737[(95%CI(0.631~0.843)];3项指标联合预测早期AKI发生的曲线下面积为0.914[(95%CI(0.823~1.000)]。结论 尿NGAL、尿ACR及血清Hcy是影响HICH患者早期AKI发生的独立危险因素,对早期AKI发生均有一定的预测价值,且三者联合预测早期AKI发生的价值更高。