尿NGAL在新生儿窒息后急性肾损伤诊治中的临床价值  

The clinical value of urinary NGAL in the diagnosis and treatment of acute renal injury after neonatal asphyxia

作　　者：张莹[1] 张碧丽[2] 王丹[1] ZHANG Ying;ZHANG Bi-li;WANG Dan(Department ofNeonatology;Department of Nephrology,Tianjin Children＇s Hospital,Tianjin 300074,China)

机构地区：[1]天津市儿童医院新生儿科,300074 [2]天津市儿童医院肾脏科,300074

出　　处：《天津医药》2018年第11期1226-1229,共4页Tianjin Medical Journal

摘　　要：目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)检测在新生儿窒息后急性肾损伤诊治中的临床价值。方法选择2016年9月—2017年9月我院新生儿科因围产期窒息住院的足月新生儿为研究对象进行前瞻性研究,根据生后1周内是否发生急性肾损伤(AKI),分为AKI组和非AKI组。检测患儿生后24 h内uNGAL水平和生后1周内血清肌酐(Scr)、尿素氮(BUN)水平,并进行组间比较。绘制ROC曲线分析生后24 h内uNGAL对窒息新生儿AKI的诊断价值。结果共纳入114例窒息新生儿,其中39例并发AKI,发生率34.2%,轻度窒息组AKI的发生率为27.2%(24/88),明显低于重度窒息组的57.69%(15/26),差异有统计学意义(P<0.05)。AKI组和非AKI组之间生后24 h内Scr、BUN水平差异无统计学意义,AKI组患儿生后24 h内uNGAL、uNGAL/Ucr显著高于非AKI组,差异均有统计学意义(P<0.05)。AKI组Ⅰ期(危险期)16例、Ⅱ期(损伤期)14例、Ⅲ期(衰竭期)9例,各期之间生后24 h内uNGAL差异有统计学意义,且随着AKI程度的加重,uNGAL水平逐渐增高(P<0.05)。绘制生后24 h内uNGAL诊断窒息新生儿AKI的ROC曲线,计算ROC曲线下面积(AUC)为0.842(95%CI:0.770～0.915,P<0.01),诊断临界值为118μg/L,此时敏感度为87.2%,特异度为94.7%。结论 uNGAL是早期诊断新生儿窒息后AKI的敏感、特异性指标,其水平升高可以反映肾功能损伤的严重程度。Objective To investigate the clinical value of urine neutrophil gelatinase-associated lipocalin （uNGAL） in the diagnosis and treatment of acute kidney injury after neonatal asphyxia. Methods A prospective study was conducted in the neonates hospitalized in our hospital for perinatal asphyxia from September 2016 to September 2017. According to whether acute kidney injury （AKI） occurred within 1 week after birth, they were divided into AKI group and non AKI group. Urine NGAL levels in 24 h after birth and serum levels of creatinine （Scr） and urea nitrogen （BUN） in 1 week after birth were detected and compared between two groups. The ROC curve was drawn to analyze the diagnostic value of uNGAL within 24 h after birth in AKI in neonatal asphyxia. Results A total of 114 cases of neonatal asphyxia were included in this study. There were 39 cases complicated with AKI, and the incidence was 34.2%. The incidence of AKI was 27.2% （24/88） in mild asphyxia group, which was significantly lower than that of the severe asphyxia group （57.69%, 15/26, P 〈 0.05）. There were no significant differences in Scr and BUN levels of 24 h after birth between AKI group and non AKI group. Values of uNGAL and uNGAL/Ucr in 24 h after birth were significantly higher in AKI group than those of non AKI group （P 〈 0.05）. In AKI group, there were 16 cases in Ⅰ stage （crisis）, 14 cases in Ⅱ stage （damage） and 9 cases in Ⅲ stage （failure）. There was significant difference in uNGAL in 24 h after birth between different stages of AKI patients. With the aggravation of AKI, the level of uNGAL gradually increased （P 〈 0.05）. The ROC curve of AKI in neonatal asphyxia diagnosed by uNGAL within 24 h after birth was drawn. The area under the ROC curve （AUC） was calculated to be 0.842 （95%CI： 0.770-0.915, P 〈 0.01）, the cut-off value was 118 μg/L, and the sensitivity was 87.2% and the specificity was 94.7%. Conclusion The uNGAL is a sensitive and specific index for early diagnosis of AKI afte

关 键 词：窒息 新生儿 急性肾损伤 中性粒细胞明胶酶相关脂质转运蛋白 

分 类 号：R722.1[医药卫生—儿科]