嗜中性粒细胞明胶酶相关载脂蛋白早期诊断冲击波碎石所致急性肾损伤的研究  

Evaluating NGAL as an early diagnostic test of ESWL-induced acute renal injury

作　　者：章璟[1] 杨佳伟[1] 顾燕[1] 姜宁[1] 王国增[1] 

机构地区：[1]上海市浦东新区公利医院泌尿外科,200135

出　　处：《中华临床医师杂志（电子版）》2014年第21期64-67,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市医学重点专科建设计划资助项目(ZK2012A29);上海市卫生局科研课题(20124310);上海市浦东新区卫生局卫生科技发展专项基金资助(PW2012A-8)

摘　　要：目的通过检测急性肾损伤的新型标记物尿嗜中性粒细胞明胶酶相关载脂蛋白（NGAL）及传统标记物α1-微球蛋白（α1-MG）在冲击波碎石（SWL）前后的变化来探讨NGAL对评价SWL引起的早期肾损伤的应用价值。方法前瞻性收集2012年7月至2013年12月来院治疗的最大径10~15 mm单发X阳性肾结石患者。用随机数字表法分为两组,观察组接受SWL（Siemens MODUALRIS Variostar电磁碎石机）,对照组接受输尿管软镜钬激光碎石（fURL）。在碎石前、碎石后2 h、6 h、12 h、24 h、48 h、1周和2周分别收集并检测尿NGAL和α1-MG水平。结果共有60例患者入选,每组各30例。所有患者为单发肾结石,位于上盏或中盏,结石平均长径11.5 mm（10~15 mm）。两组性别、年龄、结石位置、大小及基线尿NGAL值[（3.98±1.3）μg/L vs.（3.94±0.8）μg/L]、α1-MG值[（17.21±2.4）mg/L vs.（17.96±3.6）mg/L]均无统计学差异（P〉0.05）。尿NGAL值在SWL后2 h较术前已出现升高[（5.03±1.7）μg/L vs.（3.98±1.3）μg/L,P=0.008],6 h达高峰,12 h开始下降,1周接近术前基线值（P=0.048）,2周恢复基线水平[（4.03±0.9）μg/L vs.（3.98±1.3）μg/L,P=0.851]。而尿α1-MG在SWL后12 h才有轻度升高[（18.62±1.7）mg/L vs.（17.21±2.4）mg/L,P=0.012],并于24 h恢复基线水平[（17.96±3.6）mg/L vs.（17.21±2.4）mg/L,P=0.34]。对照组接受fURS后,NGAL于6 h有轻度升高[（4.52±1.2）μg/L vs.（3.94±0.8）μg/L,P=0.185],但无统计学意义,α1-MG浓度无显著变化（P=0.429）。结论 NGAL早于传统指标,在SWL后2 h已有显著升高。提示NGAL对评价SWL引起的早期急性肾损伤有潜在作用。Objective The aim of this work was to determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin （NGAL） in urine and to show the relationship between changes of this marker and conventional markersal-microglobulin （al-MG） in patients undergoing Shocknare lithotripsy （SWL）. Methods From Jul. 2012 to Dec. 2013, a prospective study was conducted to compare SWL and fURL for the management of solitary radiopaque renal calculi which were 10-15 ram in diameter. Stone formers were random enrolled into two groups by random number table. Observation group was managed with SWL （Siemens MODUALRIS Variostar lithotriptor）, while control group was managed using flexible ureteroscopy lithotripsy （fURL）. Voided urine samples were collected to detect NGAL and al-MG levels before and 2, 6, 12, 24 and 48 hours after SWL and fuRL. In addition, further urinary specimens were collected 7days and 2 weeks post-treatment. Results Of 60 patiens, 30 were randomized to the SWL group and 30 to fURL group. All patients had a single stone in the kidney with an average size of 11.5 mm （range 10-15 mm）. The gender, age, stone location, stone size, urine NGAL [（3.98 ±1.3）μg/L vs. （3.94 ± 0.8）μg/L] and α1-MG levels [（17.21 ±2.4）mg/L vs. （17.96 ± 3.6）mg/L] were comparable in both groups （P〉0.05）. Mean NGAL levels were significantly increased 2 hours post-SWL when compared with baseline [（5.03 ±1.7）μg/L vs. （3.98±1.3）μg/L, P=0.008], reached peak at 6 hours, began to decline after 12 hours, close to the baseline within 1 week （P=0.048）, and returned to baseline within 2 weeks post-SWL [（4.03 ±0.9）μg/L vs. （3.98 ±1.3）μg/L, P=0.851 ], as well as mean α1-MG levels were slightly increased 12 hours post-SWL [（18.62 ±1.7）mg/L vs. （17.21 ± 2.4）mg/L, P=0.012], and returned to baseline within 24 hours [（17.96±3.6）mg/L vs. （17.21 ±2.4）mg/L, P=0.34].There was no significant change in urinary NGAL and α1-MG levels before an

关 键 词：碎石术 肾结石 尿嗜中性粒细胞明胶酶相关载脂蛋白 急性肾损伤 

分 类 号：R699.2[医药卫生—泌尿科学]