血NGAL、CysC检测对外科重症急性肾损伤患者的早期诊断价值  

Early diagnosis value of plasma NGAL,CysC on detection of surgical critical illness patients with AKI

作　　者：刘新龙[1,2] 岳锦熙[1] 苏美仙[1] 

机构地区：[1]昆明医科大学附属第二医院重症医学科,昆明650500 [2]深圳市光明新区人民医院重症医学科,广东深圳518000

出　　处：《重庆医学》2015年第18期2506-2508,共3页Chongqing medicine

基　　金：云南省教育厅科学研究基金项目资助(2013Y293)

摘　　要：目的为了评估和比较血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血清半胱氨酸蛋白酶抑制剂C(CysC)水平在外科重症监护室(SICU)内成年急性肾损伤(AKI)患者的早期诊治中的应用价值。方法 100例患者被分入两个组:非AKI组63例和AKI组37例,应用酶联免疫吸附法(ELISA)、胶乳增强免疫比浊法(PETIA)分别测定两组患者入SICU时(T0)、入SICU后24h(T1)两个时间点血NGAL及CysC水平。结果 AKI组患者在T0、T1点的血NGAL、CysC水平明显高于非AKI组(P<0.01)。T0时血NGAL值对于AKI的诊断价值较好,在截断值为65.95ng/mL时,受试者工作曲线下面积(AUROC)为0.85,其诊断的敏感性为81.8%,特异性为76.2%;T1时血NGAL水平对于AKI的诊断价值较差,在截断值为92ng/mL时,AUROC为0.69,其诊断的敏感性为70.3%,特异性为57.1%。而T0、T1时的血CysC水平对于AKI的诊断价值更佳,在截断值分别为1.49mg/L和1.47mg/L时,其AUROC相应为0.90和0.88,其诊断的敏感性分别为89.2%、82.5%,特异性分别为83.8%、76.2%。结论血NGAL、CysC是SICU内患者预测AKI发生的早期有效新型标记物,入室时血CysC检测对于AKI的早期诊断价值要优于血NGAL。Objective To assess and compare the roles of plasma concentrations of neutrophil gelatinase associated lipocalin （NGAL） and Cystatin C for early diagnosis and treatment of septic acute kidney injury （AKI） in adult Surgical critically ill patient . Methods One hundred patients were divided into two groups ,the group of 63 cases of AKI and AKI group of 37 cases ,plasma NGAL and Cystatin C level of the 2 groups were determined by the method of enzyme‐linked immunosorbent （ELISA） ,latex en‐hanced immune turbidimetry （PETIA） respectively on arrival in the surgical intensive care unit（SICU） （T0 ） and 24 h after arrival in SICU（T1 ） .Results Compared with patients in non AKI group ,both plasma NGAL and Cystatin C level of patients in AKI group on T0 and T1 increased significantly ,the difference between the two groups had significant statistical difference （P〈0 .01）;Although ,plasma NGAL on T1 performed less well （AUC=0 .69） ,with a threshold value of 92 ng/mL（70 .3% sensitivity ,57%specificity） .Plasma NGAL showed significant discrimination for AKI diagnosis （AUC=0 .85） with a threshold value of 65 .95 ng/mL（81 .8% sensitivity ,76 .2% specificity） on T0 .Both plasma Cystatin C on T0 and T1 worked well for the diagnosis of AKI （AUC=0 .90 ,0 .88 ,thresholds 1 .49 and 1 .47 mg/L ,respectively） ,with diagnostic sensitivity of 89 .2% ,82 .5% respectively ,speci‐ficity of 83 .8% ,76 .2% respectively .Conclusion Plasma NGAL and Cystatin C are useful markers in predicting AKI in surgical critically ill patients ,the early diagnosis value of plasma Cystatin C for AKI is better than plasma NGAL on arrival in the surgical intensive care unit .

关 键 词：肾疾病 脂笼蛋白质类 半胱氨酸蛋白酶抑制剂 生物学标记 预测 SICU 

分 类 号：R692.5[医药卫生—泌尿科学]