尿NGAL在顺铂化疗肿瘤患者肾小管损伤中的临床意义探讨  

Clinical significance of urinary NGAL determination in tumor patients with renal tubular injury by cisplatin chemotherapy

作　　者：胡雷光[1] 朱立岳[1] 谢芳[2] 陈坚[1] 王昕蕾[1] 

机构地区：[1]复旦大学附属华山医院静安分院检验科,上海200040 [2]复旦大学附属华山医院静安分院肿瘤科,上海200040

出　　处：《检验医学》2013年第5期374-378,共5页Laboratory Medicine

基　　金：上海市卫生局课题基金资助项目(2010065)

摘　　要：目的探讨尿中性粒细胞明胶酶相关载脂蛋白(NGAL)检测在肿瘤化疗患者肾小管损伤的临床应用价值。方法选择58例接受顺铂(DDP)化疗的住院肿瘤患者(包括肺癌、乳腺癌、宫颈癌和腮腺癌等),收集其DDP化疗前24 h和/或DDP化疗后24 h的随机尿标本。化疗前收集57份样本并根据是否初次入院接受化疗分为已化疗组(32份)和未化疗组(25份);化疗后收集54份标本,其中53份与化疗前的标本相配对。另选取51名体检正常者作为对照组。分别检测所有对象尿NGAL、N-乙酰-β-D氨基葡萄糖苷酶(NAG)、α1-微球蛋白(α1-MG)、微量白蛋白(mAlb)和肌酐(Cr)含量,测定结果以尿Cr(UCr)进行校正(即计算前4项指标与UCr的比值)。以NAG阳性作为肾小管损伤的判断指标,将全部观察对象分为有损伤和无损伤2组,运用受试者工作特征曲线(ROC)评价尿NGAL/UCr对肾小管损伤判断的准确性。结果化疗前各组结果比较,除未化疗组NGAL/UCr和NAG/UCr高于对照组(P<0.05)外,已化疗组、未化疗组和对照组的其余项目之间差异均无统计学意义(P>0.05)。化疗前组NGAL/UCr、NAG/UCr、α1-MG/UCr[中位数(25%～75%)]分别为1.37(0.76～2.16)mg/mmol、1.30(0.76～2.56)U/mmol、0.21(0.04～0.74)mg/mmol,明显低于化疗后组[2.14(1.39～4.08)mg/mmol、2.58(1.75～4.02)U/mmol、1.00(0.30～1.91)mg/mmol](P<0.01),而mAlb/UCr化疗前、后差异无统计学意义(P>0.05)。化疗前组NGAL/UCr异常率与NAG/UCr、α1-MG/UCr及3项指标联合检测的异常率比较差异均无统计学意义(P>0.05);化疗后组NGAL/UCr和3项指标联合检测的异常率明显高于NAG/UCr、α1-MG/UCr(P<0.05)。NGAL/UCr的ROC曲线下面积(AUC)为0.770 1[95%可信区间:0.698 4～0.841 7],诊断切割点为1.15 mg/mol(灵敏度为82.09%,特异性为61.05%)。结论尿NGAL/UCr对DDP化疗患者肾小管损伤和功能减退的检出有一定的临床应用价值。对于药物性等肾毒性损伤,尿NGAL可以作为一种较为理想的生�Objective To investigate the application significance of urinary neutrophil gelatinase-associated lipocalin （NGAL） determination in tumor patients with renal tubular injury by chemotherapy. Methods The random urine specimens were collected within 24 h before and after cisplatin （ DDP ） chemotherapy in 58 tumor inpatients （including lung, breast, cervical, parotid gland cancers and so on ） who were treated by DDP chemotherapy. There were 57 urine specimens that were collected from patients before chemotherapy. They were classified into 2 groups, 25 specimens for the patients without chemotherapy and 32 specimens for the patients with once chemotherapy at least before admission. A total of 53 of 54 urine specimens after chemotherapy paired with ones before chemotherapy. A total of 51 healthy subjects were enrolled as control group. The levels of urinary NGAL, N-acetyl-beta-D-amino glucosidase （NAG） , alpha1 -microglobulin （α1 -MG） , urinary microalbumin （mAlb） and urinary creatinine （Cr） were determined.According to urinary Cr（UCr） , the 4 indicators were corrected by calculating for NGAL/UCr, NAG/UCr, α1-MG/UCr and mAlb/UCr ratio. According to the NAG positive as renal tubular injury judgment index, the all objectives were classified into 2 groups of injury and non-injury. The accuracy of renal tubular injury judged by urinary NGAL/UCr was assessed by the receiver operating characteristic （ROC） curve. Results Comparing the results of patients with chemotherapy, patients without chemotherapy before admission and controls, there was no statistical significance （ P 〉 0.05）, except NGAL/UCr and NAG/UCr of patients without chemotherapy were higher than those of controls （P 〈 0.05 ）. Of the results between patients before chemotherapy and after chemotherapy, when the median was 25%-75%, NGAL/UCr were 1. 37 （0. 76-2. 16 ） mg/mmol and 2. 14 （ 1.39- 4. 08 ） mg/mmol, NAG/UCr were 1.30 （ 0.76 - 2.56） U/mmnl and 2.58 （ 1.75 - 4.02 ） U/mmol, and eq -MG/UCr were

关 键 词：中性粒细胞明胶酶相关载脂蛋白 顺铂 化疗 肿瘤 肾小管损伤 

分 类 号：Q513[生物学—生物化学]