血浆中性粒细胞明胶蛋白酶相关载脂蛋白在危重患者中的应用性研究  

Clinical use of plasma neutrophil gelatinase - associated lipocalin （NGAL） in critically ill pafients

作　　者：刘美描[1] 邱文冰[2] 吴召熙[2] 韦深[3] 余雪涛[4] 方伟强[2] 

机构地区：[1]深圳市龙岗区人民医院呼吸内科,广东深圳518172 [2]汕头大学医学院第一附属医院ICU [3]深圳市龙岗区人民医院检验科 [4]深圳市龙岗区人民医院ICU

出　　处：《中国急救医学》2013年第8期715-718,共4页Chinese Journal of Critical Care Medicine

基　　金：广东省医学科研基金项目（A2010396）;深圳市龙岗区科技计划医疗卫生资助项目（ys2012090）

摘　　要：目的探讨血浆中性粒细胞明胶蛋白酶相关载脂蛋白（NGAL）在危重患者中的临床应用。方法ICU内38例危重患者作为研究组，检测人ICU第1天血浆中NGAL浓度，同时进行APACHEII评分及SOFA评分，记录预后。同时取17例健康成人作为对照组。血浆NGAL浓度的测定采用酶联免疫吸附法（ELISA）。结果研究组血浆NGAL浓度较对照组显著升高（P=0．034）；脓毒症患者入ICU时血浆NGAL浓度较非脓毒症患者显著升高（P=0．021），而WBC计数、体温和SOFA评分差异无统计学意义（P值分别0．129、0．974和0．428）；急性肾功能损伤（AKI）患者入[CU时血浆NGAL浓度较非AKI患者显著升高（P=0．027）；恶化组血浆NGAL浓度、APACHEII评分和SOFA评分均显著高于好转组（P值分别为0．030、0．002和0．001），血浆NGAL浓度、APACHEII评分和SOFA评分对患者死亡预测的受试者工作特征曲线（ROC曲线）下面积分别为0．717（95％C10．550—0．884，P=0．023）、0．770（95％C10．616—0．925，P=0．005）和0．796（95％C10．650～0．937，P=0．002），以NGAL等于79．56ng／mL作为预测死亡临界点，其敏感性为52．9％，特异性为90．5％。结论血浆NGAL浓度可能是反映危重患者病情及预后的一个指标，同时也可能是感染的另一敏感生化指标，但需更多的研究。Objective To detect the clinical use of the plasma neutrophil gelatinase - associated lipocalin （NGAL） in critically ill patients. Methods 38 critically ill patients in ICU were enrolled in the present study and 17 health adults as control. Blood samples were drawn from patients for NGAL measuring at ICU admission, and acute physiology and chronic health evaluation （APACHE） Ⅱ score and sequential organ failure assessment （SOFA） score was performed, and outcome was recorded as well. Plasma NGAL concentrations were measured by enzyme -linked immunosorbent assay （ELISA）. The data was settled by SPSS software 17.0. Results The plasma NGAL concentrations of ICU patients were higher than those of the controls （ P = 0. 034）, and the same as those of septic patients vs non - septic patients and acute kidney injury （AKI） vs non - AKI patients （ P values were 0. 021 and 0.027, respectively）. However, no difference of white cell count and temperature and SOFA score was found in septic and non - septic patients （P values were 0. 129, 0. 974 and 0. 428, respectively）. When admitted to ICU, the plasma NGAL concentrations of Deteriorated group elevated significantly than that of Improved group, and APACHEII and SOFA scores as well （P values were 0. 030, 0. 002 and 0. 001, respectively）. Areas under the receiver operating characteristic curves （ ROC curves） of NGAL, APACHE Ⅱ and SOFA scores for hospital mortality were 0. 717 [95% confident interval（Cl） 0.550, 0. 884, P =0. 023], 0. 770 （95% CI 0. 616, O. 925, P =0. 005） and 0. 796 （95% C10. 650, 0. 937, P=0. 002）. If 79.56 ng/ml of plasma NGAL concentration as threshold value for the prediction of death, the sensitivity and the specificity was 52. 9% and 90. 5%, respectively. Conclusion The plasma NGAL concentrations may be a predictor for the severity and the prognosis of critically ill patients. It may also be another sensitive biomarker for sepsis. However, further studies need to be done to prove it.

关 键 词：中性粒细胞明胶蛋白酶相关性载脂蛋白(NGAL) 危重患者 APACHEⅡ评分 SOFA评分 

分 类 号：R459.3[医药卫生—治疗学]