尿中性粒细胞明胶酶相关载脂蛋白对脓毒症大鼠急性肾损伤的诊断价值  

The diagnostic value of urinary neutrophil gelatinase-associated lipocalin （NGAL） to the acute kidney injured septic rats

作　　者：尚跃丰[1] 李家瑞[1] 张继翱 王文欣[1] 乔佑杰[2] 任新生[3] 

机构地区：[1]天津医院急诊科,天津300210 [2]天津市人民医院 [3]天津市泰达医院

出　　处：《中华急诊医学杂志》2015年第6期617-623,共7页Chinese Journal of Emergency Medicine

基　　金：天津市医药卫生重点学科攻关项目（10KG118）

摘　　要：目的观察脓毒症干预与否情况下尿中性粒细胞明胶酶相关载脂蛋白（uNGAL）质量浓度变化特点并评价其对急性肾损伤（AKI）的诊断价值。方法56只SD（Sprague Dawley）大鼠随机（随机数字法）分为4组，模型组（CLG）16只、血必净组（XBG）16只、黄芪注射液和柴胡注射液合用组（HCG）16只及假手术组（SOC）8只。CLG组、HCG组和XBG组以盲肠结扎穿孔术（CLP）制作脓毒症模型，造模后HCG组腹腔注射黄芪注射液和柴胡注射液；XBG组静脉注射血必净注射液；SOG组只开腹不行CLP。于术前（0h）、术后6h、12h、18h、24h、36h、48h和72h留取血清和尿液，检测血清肌酐（sCr）、尿肌酐（uCr）、尿钠（uNa）和uNGAL。绘制uNGAL质量浓度随时间变化曲线，Logistic回归分析首个6h尿量、6h处uNa和6h处uNGAL与24h内发生AKI的关系，计算受试者工作曲线（ROC）下面积（AUC）。结果CLG组、HCG组和XBG组大鼠的uNGAL均于造模后6h内迅速升高，峰值分别出现于6h处（CLG组）、24h处（HCG组和XBG组），后均快速下降；三组大鼠经同时间点uCr校正的uNGAL（cuNGAL）于造模后6h内迅速升高，峰值均出现在24h处。CLG组大鼠中发生AKI与未发生AKI大鼠的uNGAL或euNGAL随时间变化曲线几近重叠，在各时间点的浓度差异无统计学意义（uNGAL：6h，t=0．691；12h，t=1．627；18h，t=0．511。cuNGAL：6h，t=0．371；12h，t=0．474；18h，t=-1．187；均P〉0．05）；XBG组uNGAL或cuNGAL随时间变化曲线不重叠，各时间点的质量浓度差异无统计学意义（uNGAL：6h，t=1．222；12h，t=1．178；18h，t=1．272；24h，t=0．918；36h，t=0．442。cuNGAL：6h，t=1．482；12h，t=1．314；18h，t=1．280；24h，t=0．280；36h，t=0．467。均P〉0．05）。HCG组，发生AKI大鼠的uNGAL随时间变化曲线自6h后各个时间点上升幅度明显高于未发生AKI大鼠（6h，t=2．351，P〈0．05；12h，t=3．086，P〈0．01；Objective ①Observing urinary neutrophil gelatinase-associated lipocalin （uNGAL）＇s concentration variation under the intervention of sepsis; ②Evaluatingu NGAL＇ s diagnostic value for early acute kidney injury （AKI）. Method Fifty-six SD （Sprague Dawley） rats were randomly （random number） divided into four groups, including 16 rats in model group （CLG）, 16 rats in Xuebijing group （XBG）, 16 rats in Huangqi and Chaihu injection jointly applied group （HCG）, and 8 rats in sham operation group （SOG）. The septic models in CLG group, HCG group and XBG group were established by cecal ligation and puncture （CLP）. Then, the rats in HCG group was treated with intraperitoneal injectionby Huangqi and Chaihu injections; the XBG group was treated with intravenous injection by Xuebijing injection; the SOG group was treated with open surgery without CLP. After the CLP, serial urine and serum samples were obtained at baseline （just prior to operation）, 6 h, 12 h, 18 h, 24 h, 36 h, 48 h, and 72 h, and were measured by sCr, uCr, uNa, and uNGAL. The line graph of uNGAL＇ s concentration variation was plotted, based on the time. Diagnostic characteristics of urinary NGAL in predicting AKI were assessed by calculating the area under the receiver operating characteristic curve （AUC）. Results After the CLP, the uNGAL of sepsis model rats increased quickly within 6 hours. The time points of each group model reaching their peak were 6 hours after CLP in CLG groupand 24 hours after CLP in HCG group and XBG group. These groups＇ uNGAL all decreased quickly after the peak. The cuNGAL of sepsis model rats was increased quickly within 6 hours after CLP, reached its peak at 24 hours after CLP. In CLG group, the line graphs of uNGAL or cuNGAL were almost overlapped. There is little difference in the concentration of uNGAL or cuNGAL at each time point （uNGAL： 6 h, t =0.691; 12 h, t= 1.627; 18 h, t =0.511. cuNGAL： 6 h, t =0. 371 ; 12 h, t =0. 474; 18 h, t =-1. 187. Statistical significance of

关 键 词：中性粒细胞明胶酶相关载脂蛋白 生物标志物 急性肾损伤 脓毒症 盲肠结扎穿孔 受试者工作曲线 受试者工作曲线下面积 诊断 预测 

分 类 号：R459.7[医药卫生—急诊医学]