伽玛射线治疗肿瘤患者过程中血清中性粒细胞明胶酶相关脂质运载蛋白检测及其对急性肾损伤的诊断意义  

Serum levels of neutrophil gelatinase-associated lipocalin in tumor patients and its diagnostic value for acute kidney injury during gama-ray stereotactic radiosurgery

作　　者：李慧凛[1] 张金元[2] 朱义文[3] 凌贞[3] 黄健[2] 

机构地区：[1]南京军区总医院博士后科研工作站,解放军第四五五医院博士后培养点,上海200052 [2]解放军第四五五医院南京军区肾脏病专科中心 [3]解放军第四五五医院肿瘤伽马刀治疗中心

出　　处：《上海医学》2009年第3期205-209,共5页Shanghai Medical Journal

基　　金：中国博士后科学基金(20070421034)资助项目

摘　　要：目的检测伽玛射线治疗肿瘤患者过程中血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的水平,并探讨其对急性肾损伤(AKI)的诊断意义。方法收集解放军第四五五医院2007年5—11月接受体部伽玛射线治疗的100例肿瘤患者的临床资料,以伽玛射线治疗过程中血清肌酐上升>26.52μmol/L或较基础值上升>50%为AKI的诊断标准。前瞻性观察伽玛射线治疗过程中发生AKI的肿瘤患者的血清NGAL水平变化。结果100例肿瘤患者中,25例发生AKI。在造影12 h,AKI组的血清NGAL水平显著高于无AKI组(P<0.01),而两组间血清肌酐水平的差异无统计学意义(P>0.05)。在造影48 h,AKI组间血清NGAL及肌酐水平均显著高于无AKI组(P值均<0.01)。伽玛射线治疗7次后,两组间血清NGAL及肌酐水平的差异均无统计学意义(P值均>0.05)。治疗结束时,两组间血清NGAL水平的差异无统计学意义(P>0.05),但AKI组的血清肌酐水平显著高于无AKI组(P<0.05)。接受造影剂检查后12 h的血清NGAL水平与接受伽玛射线治疗过程中血清肌酐峰值水平(r=0.321)及血清肌酐峰值与基础值的差值(r=0.392)均呈正相关(P值均<0.01)。以造影12 h时的血清NGAL水平诊断AKI发生的敏感度和特异度,其受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.776(95%CI为0.675～0.878,P<0.05),与完全随机情况下获得的曲线下面积(AUC)为0.5的差异有统计学意义(P<0.05)。以造影48 h时的血清NGAL水平绘制ROC曲线的AUC为0.674(95%CI为0.558～0.789),根据造影剂检查后12 h时的血清NGAL水平绘制的ROC曲线以确定血清NGAL在诊断AKI的临界点,曲线上最靠右上方的点检验的敏感度和特异度均较高。结论与血清肌酐相比,造影12 h时检测患者的血清NGAL水平,可以更早期地诊断肿瘤患者接受伽玛射线治疗过程中发生的AKI,其诊断的准确度较高,有较好的敏感度和特异度。Objective To assess whether serum neutrophil gelatinase-associated lipocalin （NGAL） can be used for diagnosis of acute kidney injury in tumor patients treated with gama-ray stereotactic radiosurgery （Gama knife）. Methods A total of 100 tumor patients admitted to our hospital were treated with Gama knife radiotherapy from May 2007 to Nov. 2007. Acute kidney injury （AKI） was defined as the absolute increment over 26.52 μmol/L or a 50% increase of serum creatinine from the baseline. All patients used the Iow-osmolar nonionic contrast medium before treated with Gama knife. The clinical features and the incidence of AKI were prospectively observed. The serum NGAL levels were prospectively observed in tumor patients with AKI during the treatment with Gama knife and the influencing factors were discussed. Results Twenty-five of the 100 patients developed acute kidney injury. The serum NGAL in AKI group was significantly higher than that of non-AKI group （P〈0.01） 12 h after intravenous injection of contrast medium; the levels of creatinine were similar between the two groups. 48 h after contrast injection, the NGAL and creatinine levels in AKI group were significantly higher than those of the on-AKI group （P〈0.01）. Seven days after Gama knife treatment, the NGAL and creatinine levels were similar between the two groups. At the end of treatment the NGAL levels were similar between the two groups; the creatinine level in AKI group was significantly higher than that in the non-AKI group （ P〈0.05）. According to the sensitivity and speciticity of NGAL, ROC curves were drawn; 12 h after injection of contrast, AUC was 0.776 （95% CI, 0.675-0.878, P〈0.05）, and for 48 h it was 0.674（95% CI= 0.558--0.789）. Conclusion Compared with creatinine, NGAL level 12 h contrast injection allows for earlier diagnosis of AKI, with high accuracy and satisfactory sensitivity and specificity. （Shanghai Med J, 2009, 32= 205-209）

关 键 词：急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 立体定向放射治疗 造影剂肾损伤 

分 类 号：R730.5[医药卫生—肿瘤] R692[医药卫生—临床医学]