尿液中性粒细胞明胶酶相关载脂蛋白应用于早期诊断对比剂肾病的价值  

The value of urinary neutrophil gelatinase-associated lipocalin for early detection of contrast-induced nephropathy

作　　者：张翩[1] 王玲[1] 倪兆慧[1] 何奔[2] 沈玲红[2] 王肖龙[3] 邱建平 郑昌柱[5] 杨光敏[6] 孙静[3] 林捷 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海200127 [2]上海交通大学医学院附属仁济医院心内科,上海200127 [3]上海中医药大学附属曙光医院心内科 [4]上海浦东新区公利医院心内科 [5]上海市第七人民医院心内科 [6]上海市浦东新区浦南医院心内科

出　　处：《上海医学》2013年第3期194-199,共6页Shanghai Medical Journal

基　　金：浦东新区科技发展基金创新资金(PKJ2009-Y12);浦东新区社会发展局课题(PW2007D-3);国家自然科学基金面上项目(81070548)资助

摘　　要：目的探讨尿液中性粒细胞明胶酶相关载脂蛋白(NGAL)应用于早期诊断对比剂肾病(CIN)的价值。方法在5个中心前瞻性收集行冠状动脉造影(CAG)患者的临床资料,将发生CIN者纳入CIN组(17例),另在入选患者中选取与CIN患者临床资料匹配的非CIN者纳入非CIN组(17例)。检测两组患者在CAG前后多个时间点的尿液NGAL、尿液N-乙酰-β-D氨基葡萄糖苷酶(NAG)、血清肌酐(sCr)、血清胱抑素C(CyC)水平,分析尿液NGAL作为CIN早期标志物的价值。结果 CIN组的CAG持续时间显著长于非CIN组(P<0.05)。CIN组在CAG后2、6、12、24h时的尿液NGAL水平均显著高于同组基线值(P值分别<0.05、0.01),非CIN组在CAG前后各时间点尿液NGAL水平的差异均无统计学意义(P值均>0.05),一直维持在较低水平。CIN组在CAG后6、12h时的尿液NGAL水平均显著高于非CIN组同时间点(P值分别<0.05、0.01)。CAG后6、12h时尿液NGAL值诊断CIN的受试者工作特征曲线下面积分别为0.713(95%CI为0.534～0.892,P=0.034)和0.772(95%CI为0.612～0.931,P=0.007)。CIN组在CAG后2、6h时的尿液NAG水平均显著高于同组基线值(P值均<0.05),非CIN组在CAG后2、6、12、24h时的尿液NAG水平均显著高于同组基线值(P值分别<0.05、0.01),两组间在CAG前后各时间点的尿液NAG水平的差异均无统计学意义(P值均>0.05)。CIN组在CAG后72h时的血清CyC水平均显著高于非CIN组同时间点(P<0.05),CAG后48、72h的sCr水平显著高于非CIN组同时间点(P值分别<0.01、0.05)。结论尿液NGAL对早期诊断CIN的价值优于尿液NAG、sCr及血清CyC。Objective To determine the value of urinary neutrophil gelatinase-associated lipocalin （NGAL） as a early biomarker for contrast-induced nephrology （CIN）. Methods Patients from five medical centers undergoing coronary angiography （（gAG） were prospectively enrolled in the study and their clinical data were collected. Seventeen patients developed CIN （（giN group）, and another 17 patients without （giN and whose clinical data were not different from the （giN subjects were selected into non-（giN group. Urinary NGAL and N- acetyl-β-D-glucosaminidase （NAG）, and serum creatinine and cystatin C were measured at serial time points. The value of urinary NGAL for early diagnosis of （giN was analyzed. Results The duration of （gAG in （giN group was significantly longer than that in non-（giN group （P〈0.05）. （gompared with the baseline, NGAL levels at 2, 6, 12 and 24 h after （gAG were siqnificantly increased in CIN clroup （P〈O. 05, 0.01）. But NGAL in non-CIN aroup kept at a low level and the difference before and after CAG was not statistically significant （P〈0.05）. NGAL levels in CIN group were significantly higher than those in non-CIN group at 6 h and 24 h after CAG （P〈0.05, 0.01）. For urinary NGAL, area under the receiver-operating characteristics curve （AUC） was 0.713 （95 % OI = 0. 534--0. 892, P = 0. 034） at 6 h and 0. 772 （95% CI 0. 612--0. 931, P = 0. 007） at 12 h after CAG. Compared with the baseline, NAG levels in CIN group at 2 h and 6 h after CAG and in non-CIN group at 2, 6, 12 and 24 h after CAG were significantly increased （P〈0.05, 0.01）. There was no significant difference in NAG between the two groups at any time point （P〉0.05）. Serum cystatin C in CIN group was significantly higher than that in non-CIN group at 72 h after CAG （P〈0.05）, so was serum creatinine at 48 h and 72 h after CAG （P〈0.05）. Conclusion Urinary NGAL is superior to NAG, serum creatinine and Cystatin C for the early diagnosis of CIN. （Shang

关 键 词：尿中性粒细胞明胶酶相关载脂蛋白 尿N-乙酰-Β-D氨基葡萄糖苷酶 对比剂.肾病 生物标志物 早期诊断 

分 类 号：R816.2[医药卫生—放射医学] R692.9[医药卫生—临床医学]