生物标志物NGAL、NAG、胱抑素C诊断对比剂急性肾损伤的价值  

Urinary neutrophil gelatinase-associated lipocalin as an early biomarker for contrast-induced nephropathy after coronary angiography

作　　者：张翩[1] 王玲[1] 何奔[1] 王肖龙 邱建平 郑昌柱 杨光敏 庞慧华[1] 沈剑箫[1] 牟姗[1] 倪兆慧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科,上海200127

出　　处：《兰州大学学报（医学版）》2018年第1期7-13,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：浦东新区科技发展基金创新资金项目(PKJ2009-Y12);上海市重大科研项目(08DZ1900500);上海市卫计委综合医院中西医结合专项(2015-2017年)重点项目(ZHYY-ZXYJHZX-1-02);国家自然科学基金项目(81370794;81570604);上海市卫生和计划生育委员会科研项目(20134095)

摘　　要：目的探讨尿中性粒细胞明胶酶相关载脂蛋白(NGAL)、尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)和血清胱抑素C对对比剂急性肾损伤(CI-AKI)的早期诊断价值。方法前瞻性收集行冠状动脉造影患者临床资料,将发生CI-AKI患者纳入CI-AKI组(17例),另选取与CI-AKI患者临床资料匹配者纳入非CI-AKI组(17例)。检测CI-AKI组和非CI-AKI组患者尿液及血液标本NGAL、NAG、血清肌酐、血清胱抑素C水平,分析这些标志物在冠状动脉造影前后的变化以及尿NGAL作为CI-AKI早期标志物的价值。结果 CI-AKI组患者冠状动脉造影后2、6、12、24 h尿NGAL水平显著高于基础值(均P<0.05),非CI-AKI组患者冠状动脉造影前及造影后各时间点尿液NGAL水平差异均无统计学意义。冠状动脉造影后6 h和12 h,CI-AKI组患者尿液NGAL水平高于非CI-AKI组(P<0.05),尿NGAL诊断CI-AKI的ROC曲线下面积分别为0.713(95%CI为0.534—0.892,P=0.034)和0.772(95%CI为0.612—0.931,P=0.007)。2组患者尿NAG水平在造影后2 h和6 h均高于基础值(P<0.05),但2组患者间尿NAG水平在冠状动脉造影前及造影后各时间点差异均无统计学意义。冠状动脉造影后72 h,CI-AKI组患者血清胱抑素C水平高于CI-AKI组(P<0.05);48 h和72 h,CI-AKI组患者血清肌酐水平高于CI-AKI组(P<0.05)。结结论尿NGAL对CI-AKI损伤反应最敏感,尿NAG、血清胱抑素C和血清肌酐反应滞后于NGAL。Objective To determine urinary neutrophil gelatinase-associated lipocalin （uNGAL） as a biomarker for early detection of acute kidney injury. Methods Patients from five centers undergoing coronary angiogra-phy with contrast medium exposure were prospectively enrolled. Serial urine samples were prospectively obtained from all patients at baseline, 2, 6, 12, 24, 48 and 72 h after CAG, and serum samples were collected too. Urinary NGAL and NAG, serum cretinine and cystatin C were measured and analyzed. CI-AKI was diag- nosed in 17 patients （CI-AKI group） and 17 patients without CI-AKI matched with the CI-AKI subjects were selected into control group. Results Urinary NGAL levels were significantly increased in the CI-AKI group at 2, 6, 12, 24 h after CAG compared with the baseline, and 2 h and 6 h-uNGAL differed significantly between CI-AKI and non-CI-AKI group. The predictive power ofuNGAL was demonstrated by area under the receiver- operating characteristics curve for diagnosis of CI-AKI at 6, 12 h after CAG was 0.713 and 0.772, respectively. Urinary NAG showed no difference between CI-AKI and non-CI-AKI groups at any time-point. Serum creati- nine in CI-AKI group differed significantly 48 and 72 h after CAG compared with non-CI-AKI group, and serum cystatin C differed significantly 72 h after CAG compared with non-CI-AKI group. Conclusions Uri- nary NGAL is an early biomarker for CI-AKI, which facilitates the diagnosis of CI-AKI. Serum crerinine or cystatin C is not good marker for the early detection of CI-AKI.

关 键 词：尿中性粒细胞明胶酶相关载脂蛋白 尿N-乙酰-Β-D氨基葡萄糖苷酶 对比剂急性肾损伤 生物标志物 早期诊断 

分 类 号：R692[医药卫生—泌尿科学]