尿中性粒细胞明胶酶相关脂质运载蛋白在危重病患者急性肾损伤早期诊断中的意义  

Eearly diagnostic value of urinary NGAL in acute kidney injury in critically ill patients

作　　者：徐兴凯[1] 李岩[2] 余猛进[3] 王玺[1] 林兆奋[1] 张连东[4] 单红卫[1] 

机构地区：[1]第二军医大学附属长征医院急救科,上海200003 [2]上海交通大学附属第一人民医院危重病急救科 [3]上海市浦东新区人民医院急诊科 [4]上海中医药大学附属曙光医院宝山分院急诊科

出　　处：《中华急诊医学杂志》2013年第5期505-510,共6页Chinese Journal of Emergency Medicine

摘　　要：目的评估尿液中的中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）对监护病房（ICU）中危重病患者急性肾损伤（AKI）的预测价值。方法研究对象是分别来自三家综合性医院ICU的110例患者。患者均为18岁以上成年人，入ICU后连续观察72h，根据AKI诊断的REFLE标准将患者分为AKI组33例和非AKI组77例。根据脓毒症诊断标准将患者又分为脓毒症组79例和非脓毒症组31例。排除标准为慢性肾功能不全、恶性肿瘤、人ICU24h内死亡患者。每天检测患者的血肌酐和uNGAL。比较分析脓毒症与非脓毒症患者、AKI与非AKI患者、脓毒症合并AKI与脓毒症非AKI患者之间uNGAL的差异，以及AKI与非AKI患者入ICU第24小时的血肌酐和uNGAL之间的差异，应用ROC曲线评价uNGAL和血肌酐对ICU患者AKI诊断的敏感性和特异性。结果脓毒症与非脓毒症患者之间，AKI与非AKI患者之间，脓毒症合并AKI与脓毒症非AKI患者之间的uNGAL质量浓度差异具有统计学意义。在人ICU第24小时AKI与非AKI患者uNGAL质量浓度差异具有统计学意义，血肌酐浓度差异无统计学意义。患者入ICU第24小时的uNGAL和血肌酐的ROC曲线下面积分别为0．828（95％CI：0．742～0．914）和0．583（95％CI：0．471～0．695）。uNGAL的cutoff值为170ng／ml，敏感性和特异性分别为0．778和0．784，敏感性优于血肌酐。结论uNGAL在诊断AKI方面优于血肌酐，能够作为ICU患者AKI早期诊断的标志物。Objective To estimate the predictive value of neutrophil gelatinase-associated lipocalin in urine （uNGAL） for detection of acute kidney injury （AKI） in the intensive care unit （ICU） critically ill patients. Methods A total of 110 patients from the ICU of three general hospitals were enrolled in the study. The patients were adults more than 18 years of age. After admitted to ICU, the patients were continuously observed for 72 hours. According to the RIFLE criteria for diagnosis of AKI, the patients were classified as AKI group （33 cases） or non-AKI （77 cases）. According to the sepsis diagnostic criteria, the patients were classified as sepsis （79 cases） or non-sepsis （31 cases）. Exclusion criteria of patients were chronic renal insufficiency, malignant tumor, death after admitted to ICU 24 hours. Serum ereatinine and uNGAL of the patients were analyzed daily. The difference of uNGAL between sepsis and non-sepsis patients, AKI and non-AKI patients, sepsis non-AKI and sepsis AKI patients was compared. Moreover, the difference of serum creatinine and uNGAL between AKI and non-AKI patients into ICU 24 h was compared, and the sensitivity and specificity of uNGAL and serum ereatinine for diagnosis of AKI in the ICU patientswere evaluated using ROC curve. Results The uNGAL levels were all significantly different between sepsis and non-septis patients, AKI and non-AKI patients, sepsis concomitant AKI and sepsis without AKI patients. The uNGAL levels were significantly different between AKI and non-AKI patients in ICU for the first 24 h, while the difference of serum creatinine were not significant. The area under receiver operating characteristic （ROC） curve of uNGAL and serum creatinine of patients in ICU for the first 24 h were 0. 828 （95% CI： 0.742- 0.914） and 0.583 （95% CI： 0.471- 0.695）, respectively. The cutoff value of uNGAL was 170 ng/ml, and the sensitivity and specificity were 0. 778 and 0. 784, respectively. The sensitivity was superior to serum creatinine. Conclusion

关 键 词：中性粒细胞明胶酶相关脂质运载蛋白 血肌酐 脓毒症 急性肾损伤 敏感性 特异性 

分 类 号：R692[医药卫生—泌尿科学]