血清肌酐、胱抑素C、NGAL检测对妊娠相关急性肾损伤诊断及预后评估的价值  

The value of testing SCr,Cys C,and NGAL on diagnosis and prognosis prediction of pregnancy related acute kidney injury of pregnant women

作　　者：李平华[1] 宋倩[1] 黄连铭 

机构地区：[1]冀中能源邢台矿业集团有限责任公司总医院产科,邢台054000

出　　处：《中国计划生育学杂志》2017年第5期308-313,共6页Chinese Journal of Family Planning

摘　　要：目的:探讨血清肌酐(SCr)、胱抑素C(Cys-C)、中性粒细胞明胶酶相关载脂蛋白(NGAL)检测对妊娠相关急性肾损伤(RP-AKI)诊断及预后评估的价值。方法:将RP-AKI患者93例按照产后随访结果分为预后不佳组27例和预后良好组66例,另选择100例正常分娩的产妇作为对照组,采用肌氨酸氧化酶法检测SCr水平,乳胶增强免疫透射比浊法检测血清Cys-C水平,双抗夹心酶联免疫吸附实验检测血清NGAL水平,logistic多元回归分析RP-AKI或预后不佳的危险因素,利用受试者工作曲线(ROC)预测SCr、Cys-C、NGAL对RP-AKI或预后不佳的诊断价值。结果:RP-AKI组SCr、Cys-C、NGAL水平均高于对照组(P<0.05)。产后3个月、6个月、12个月,预后不佳组SCr、Cys-C、NGAL水平均高于预后良好组(P<0.05)。相关性分析显示,RP-AKI组血清SCr水平与Cys-C和NGAL均呈正相关(均P<0.05),Cys-C与NGAL呈正相关(P<0.05)。logistic回归分析显示,SCr、Cys-C、NGAL是RP-AKI预后不佳的独立危险因素(均P<0.05)。NGAL诊断RP-AKI的最佳临界值为17.98μg/L,敏感度为82.7%,特异度为87.9%,ROC曲线下面积(AUC)为0.946(P<0.05),NGAL诊断RP-AKI的AUC高于SCr(AUC 0.851)和Cys-C(AUC 0.817)(均P<0.05)。SCr预测RP-AKI预后不佳的最佳临界值为127.63μmoI/L,敏感度为79.4%,特异度为83.1%,ROC曲线下面积为0.893(P<0.05),SCr预测RP-AKI预后不佳的AUC高于Cys-C(AUC0.754)、NGAL(AUC0.803)(P<0.05)。结论:NGAL对RP-AKI的诊断价值高于SCr和Cys-C,SCr对RP-AKI预后的预测价值高于Cys-C和NGAL。Objective：To explore the value of testing serum creatinine （SCr）,Cystatin C （Cys C）,and neutrophil gela tinase associated lipocalin （NGAL） on diagnosis and prognosis prediction of pregnancy related acute kidney injury（RPAKI） of pregnant women.Methods：A total of 93 patients with RP-AKI （the RP-AKI group） were divided into the poor prognosis group （27 cases） and the eusemia groups （66 cases） according to the result of postpartum follow-up,another 100 cases of normal parturient were in the control group.The SCr levels was detected by sarcosine oxidase as say,serum Cys C level was detected by latex-enhanced immunoturbidimetric assay,serum NGAL level was detected by dual sandwich enzyme linked immunosorbent assay,risk factors for RP-AKI or poor prognosis were analyzed by logistic multiple regression,the diagnosis and prognosis prediction value of SCr,Cys C,NGAL for RP-AKI were evaluated by receiver operating curve （ROC）.Results：The SCr,Cys C,NGAL level of patients in the RP-AKI group were significant higher than those of patients in the control group （P〈0.05）.In 3 months,6 months,and 12 months post partum,the level of SCr,Cys C,and NGAL of patients in the poor prognosis group were significant higher than those of patients in the eusemia group （P〈0.05）.Correlation analysis showed that for patients in RP-AKI group,there was positive correlation between serum SCr and Cys C （P〈0.05）,serum SCr level was positively correlated with NGAL （P〈0.05）,Cys C was positively correlated with NGAL （P〈0.05）.Logistic regression analysis showed that level of SCr,Cys C and NGAL were independent risk factors for poor prognosis in patients with RP-AKI （P〈0.05）.The optimal cut-off value of NGAL level as an indicator for diagnosing RP-AKI was 17.98μg/L,which yielded a sensitivity was 82.7% and a specificity was 87.9%,and its area under the curve （AUC） was 0.946 （P〈0.05）,the AUC of NGAL level for diagnosing RP-AKI was higher than that of SCr level （AUC：0.85

关 键 词：肌酐 胱抑素C 中性粒细胞明胶酶相关载脂蛋白 妊娠相关急性肾损伤 

分 类 号：R714.6[医药卫生—妇产科学]