NGAL早期升高对复苏后患者预后的影响  

Effect of early increase of NGAL on prognosis of patients after resuscitation

作　　者：邵斌霞 费立博 何斌[2] 曹丽萍[1] 邵旦兵 杨志洲 任艺 聂时南[1] 

机构地区：[1]中国人民解放军南京总医院急救医学科,南京210002 [2]南京医科大学第一附属医院急诊科

出　　处：《临床急诊杂志》2017年第11期816-819,共4页Journal of Clinical Emergency

基　　金：中国人民解放军南京总医院院内课题(No:2015024)

摘　　要：目的:探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对复苏后患者急性肾损伤(AKI)的早期诊断以及预后判断的意义。方法:前瞻性研究2012-01-01-2017-01-01期间中国人民解放军南京总医院和南京医科大学第一附属医院收治的心搏骤停(CA)后达到自主循环恢复(ROSC)患者,共56例。收集复苏即刻,复苏后6h、12h、24h、48h血清、尿液样本,测定血肌酐、血NGAL以及尿NGAL的水平。根据急性肾损伤网络组织(AKIN)诊断标准将入选患者分为AKI组(15例)和非AKI组(41例),比较不同时间点两组患者肾损伤标志物的差异;比较存活与死亡患者6h时血及尿NGAL水平差异、AKI发生率以及住院时间。结果:AKI组的血和尿NGAL浓度分别在6h、24h明显高于非AKI组相应的时间点,死亡组血和尿NGAL的水平在复苏后6h时明显升高,且AKI的发生率亦明显升高。结论:对于复苏后达到ROSC的患者,早期血和尿NGAL的升高可能提示更高的AKI发生率,以及预后不良。Objective：To investigate the effect of neutrophil gelatinase-associated lipocalin（NGAL）on early diagnosis and prognosis of acute renal injury（AKI）in patients after resuscitation.Method：This was a prospective observational study of patients with return of spontaneous circulation（ROSC）who underwent cardiac arrest（AC）in the Nanjing General Hospital and First Affiliated Hospital of Nanjing Medical University between January 1,2012 and January 1,2017.A total number of 56 patients were enrolled.We obtained blood and urine samples from each subject at enrollment,6,12,24,and 48 hours after return of spontaneous circulation.We measured the levels of serum creatinine,NGAL and urine NGAL.According to the diagnostic criteria of acute kidney injury network（AKIN）,the patients were divided into AKI group（n=15）and non-AKI group（n=41）.The changes of renal injury markers were compared between the two groups at different time points.We compared serum and urine NGAL concentrations at 6 hpoint,AKI incidence and hospitalization time between survivors and nonsurvivors.Result：The serum and urine NGAL concentrations of AKI group were significantly higher than those of non-AKI group at 6 h and 24 hrespectively.The levels of serum and urine NGAL were higher in nonsurvivors than survivors at 6 h,and the incidence of AKI was also significantly increased in nonsurvivors.Conclusion：In patients with ROSC after resuscitation,early elevated serum and urine NGAL levels may indicate a higher incidence of AKI and poor prognosis.

关 键 词：心脏骤停 自主循环恢复 中性粒细胞明胶酶相关脂质运载蛋白 急性肾损伤 

分 类 号：R542.2[医药卫生—心血管疾病]