中性粒细胞明胶酶相关载脂蛋白在腹透相关性腹膜炎中的诊断价值  

Diagnostic value of neutrophil gelatinase-associated lipocalin on peritoneal dialysis related peritonitis

作　　者：章圣泽 黄文[2] 贾李跃 王牡丹 朱源 董芍芍 周丽娜 ZHANG Shengze,HUANG Wen,JIA Liyue ,et al.(Department of Nephrology,Wenzhou People＇s Hospital,Wenzhou 325000,Chin)

机构地区：[1]温州市人民医院肾内科,浙江温州325000 [2]温州医科大学附属第二医院育英儿童医院肾内科

出　　处：《全科医学临床与教育》2018年第5期516-519,共4页Clinical Education of General Practice

基　　金：温州市科技计划项目(Y20170304)

摘　　要：目的探讨中性粒细胞明胶酶相关载脂蛋白(NGAL)在腹透相关性腹膜炎(PDRP)中的变化及诊断价值。方法选取因腹透相关性腹膜炎住院治疗患者38例作为PDRP组,普通腹膜透析患者34例作为非PDRP组。检测两组患者首诊日、第3天、第7天、第14天的腹透液NGAL(P-NGAL)、腹透液白细胞(P-WBC)、腹透液中性粒细胞(PNeu)、腹透液白介素-1β(P-IL-1β)及血NGAL(S-NGAL)、血白细胞(S-WBC)、血中性粒细胞(S-Neu)、血CRP(SCRP)等指标,并采用ROC曲线评价指标的灵敏度和特异度。结果 PDRP组患者的首诊日P-NGAL、P-WBC、P-IL-1β及S-NGAL、S-WBC、S-Neu、S-CRP明显高于非PDRP组,差异均有统计学意义(t分别=3.12、11.23、2.17、2.45、1.81、0.91、3.32,P均<0.05)。治疗第3天,PDRP组患者P-NGAL、S-NGAL较首诊日明显下降(t分别=4.56、7.78,P均<0.05),第7天,PDRP组患者P-NGAL、S-NGAL较第3天明显下降(t分别=5.97、6.21,P均<0.05),第14天P-NGAL明显低于第7天(t=4.89,P<0.05)。ROC曲线中,P-NGAL的AUC为0.88,最佳截断值69.50 ng/ml,诊断PDRP阳性的灵敏度为81.70%,特异度为89.20%。S-NGAL的AUC为0.85,最佳截断值50.40 ng/ml,诊断PDRP阳性的灵敏度为85.21%,特异度为85.52%。结论 NGAL在PDRP患者中明显升高,随着治疗有效而下降。NGAL是预测PDRP有效的生物标志物,可用来监测治疗。Objective To evaluate the expression and diagnostic value of neutrophil gelatinase-associated lipocalin（NGAL）in patients with peritoneal dialysis-related peritonitis. Methods Totally 38 patients with peritoneal dialysisrelated peritonitis were enrolled for PDRP group,and 34 patients of common peritoneal dialysis were selected for the control group. The peritoneal dialysis fluid-NGAL（P-NGAL）,peritoneal dialysis-white blood cell（P-WBC）,peritoneal dialysis fluid-neutrophile granulocyte（P-Neu）,peritoneal dialysis fluid-Interleukinin-1β（P-IL-1β）and serum-NGAL（SNGAL）,serum-white blood cell（s-WBC）,serum-neutrophile granulocyte（S-Neu）,and serum-C-reactive protein（SCRP）were examined at first,third,seventh,fourteenth day. ROC curve analysis curve area was used to calculate the sensitivity and specificity for evaluating diagnosis of NGAL. Results Compared to the control group,the P-NGAL,PWBC,P-IL-1β,S-NGAL,S-WBC,S-Neu,S-CRP were significantly higher in PDRP group at first day（t=3.12,11.23,2.17,2.45,1.81,0.91,3.32,P〈0.05）. The P-NGAL and S-NGAL were significantly declined at the third day when compared with the first day（t=4.56,7.78,P〈0.05）. The P-NGAL and S-NGAL were significantly declined at the seventh day when compared with the third day（t=5.97,6.21,P〈0.05）.The P-NGAL was significantly declined at the fourteenth day when compared with the seventh day（t=4.89,P〈0.05）.The AUC of p-NGAL was 0.88,the cut off value was 69.50 ng/ml,and the sensitivity and specificity of diagnosing PDRP were 81.70% and 89.20%. The AUC of S-NGAL was0.85,the cut off value was 50.40 ng/ml,and the sensitivity and specificity were 85.21% and 85.52%.Conclusion The NGAL increases significantly in PDRP patients,and decreases with effective treatment.The NGAL is a reliable biomarker for diagnosing PDRP,a good biological indicator to monitor therapeutic effect.

关 键 词：腹透相关性腹膜炎 中性粒细胞明胶酶相关载脂蛋白 白介素-1Β 肿瘤坏死因子-Α 

分 类 号：R459.5[医药卫生—治疗学]