终末期肾病患者血液透析前后血清中性粒细胞明胶酶相关脂质运载蛋白的改变及意义——附10例报告  

Alteration and significance of serum neutrophil gelatinase-associated lipocalin in end stage renal disease with hemodialysis

作　　者：姚于泓[1] 何小洁[1] 王琳[1] 杨毅华[1] 陈慎仁[1] 

机构地区：[1]广东汕头大学医学院第二附属医院内科,应届硕士生研究生515041

出　　处：《新医学》2009年第9期577-580,共4页Journal of New Medicine

基　　金：广东省科技计划(社会发展)基金资助项目(2006B36005007)

摘　　要：目的:探讨中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-asso-ciated lipocalin,NGAL)在终末期肾病(end-stage renal disease,ESRD)患者血液透析前后的变化及其临床意义。方法:以10例符合K/DOQI专家组标准的慢性肾衰竭患者为观察组,分别于血液透析治疗前在未流经透析器的动脉端、透析后回输血液前静脉端采血,检测其血清NGAL、血清肌酐、血尿素氮、胱抑素C、超敏C-反应蛋白(hypersensitive C-reative protein,hsCRP),同时与15名健康人(对照组)的血清NGAL水平作对比,并分析血液透析前后血清NGAL水平与血清肌酐、血尿素氮、胱抑素C、hsCRP的相关性。结果:血液透析前观察组血清NGAL水平明显高于对照组(P<0.01);血液透析后观察组血清NGAL水平比血液透析前有所下降(P<0.05),与对照组比较差异无统计学意义(P>0.05)。血液透析后观察组的血尿素氮、血清肌酐均比血液透析前明显下降(P<0.01),胱抑素C则略有升高(P<0.05),hsCRP无明显改变(P>0.05)。血清NGAL与血清肌酐、血尿素氮、胱抑素C、hsCRP均无关(均为P>0.05)。结论:ESRD患者血清NGAL水平明显高于正常人群。血清NGAL值明显升高有望作为血液透析适应证指标之一。经单次、普通血液透析后,血清NGAL水平明显下降,其下降幅度可作为评估血液透析充分性的参考指标之一。Objective： To explore the role of neutrophil gelatinase-associated lipocalin （NGAL） played in the end stage renal disease （ESRD） by observing its changes before and after hemodialysis （ HD）, and to identify its clinical significance. Methods： Ten patients with chronic renal failure were enrolled as an observation group, and blood sample was respectively fetched from artery （not through the dialyzer end of the artery） before HD and vein （before blood transfusion） after HD. Levels of NGAL protein, serum creatinine （Scr）, blood urea nitrogen （BUN）, cysctatin C （Cys-C）, and hypersensitive C-reative protein （hsCRP） were detected. NGAL were also measured in 15 health volunteer （control group）. Relationship of NGAL and Scr, BUN, Cys-C and hsCRP were analyzed pre-and post-dialysis. Results： NGAL of ESRD was obviously higher in pre-dialysis compared with the control group （ P 〈 0. 01）, NGAL of ESRD in post-dialysis was lower than of pre-dialysis （ P 〈 0. 05）, but NGAL was not shown a significantly difference between the post-dialysis group and the control group （ P 〉0. 05）. A sharp reduction of both BUN and Scr were displayed after dialysis （P 〈 0.01）. A rise tendency of Cys-C after dialysis was observed （ P 〈 0.05）. No difference of hsCRP was revealed after dialysis. No correlation could be shown between NGAL and Scr, BUN, Cys-C and hsCRP （P〉0.05）. Conclusion： The levels of NGAL in patients with ESRD are obviously higher than the healthy people. High concentration of serum NGAL might be one of indication in HD. NGAL is reduced significantly after single and simple HD, so it reflects HD effect and comes to be another marker to evaluate HD effect in the future.

关 键 词：中性粒细胞明胶酶相关脂质运载蛋白 终末期肾病 慢性肾衰竭血液透析 血清肌酐 血尿素氮 胱抑素C 超敏C-反应蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]