血清NGAL和CysC用于ACLF相关AKI的诊断价值研究  

Diagnostic value of serum NGAL and CysC levels for ACLF-related AKI Diagnostic value of serum NGAL and Cys Clevels in ACLF patients with AKI

作　　者：武超玉 唐公恩 王万鹏[2] 李云 WU Chaoyu;TANG Gong’en;WANG Wanpeng;LI Yun(Department of Infectious Disease,Central Hospital of Linyi City,Shandong,Linyi 276400,China)

机构地区：[1]山东省临沂市中心医院感染科,276400 [2]山东省潍坊市人民医院感染科

出　　处：《河北医药》2018年第21期3218-3222,共5页Hebei Medical Journal

摘　　要：目的探讨血清NGAL及Cys C水平用于慢加急性肝衰竭(ACLF)相关急性肾损伤(AKI)的临床诊断价值。方法选择2013年5月至2016年5月住院的ACLF患者245例,根据是否发生AKI分为AKI组(n=112)及无AKI组(n=133)。记录患者一般情况及常规实验室指标,使用酶联免疫方法检测血清NGAL及Cys C水平。分析NGAL及Cys C水平与临床指标的相关性,ROC曲线检测指标的诊断效能。结果与无AKI组相比,AKI组NGAL水平[(83. 35±22. 89) vs(57. 03±20. 93) ng/ml,P <0. 01]及Cys C水平[(1. 55±0. 64) vs(0. 98±0. 46)μg/dl,P <0. 01]更高。AKI组中,NGAL水平与Scr(r=0. 352,P <0. 01)、MELD评分(r=0. 319,P=0. 01)、Cys C(r=0. 558,P <0. 01)及AKI分期(r=0. 605,P <0. 01)呈显著正相关,与e GFR(r=-0. 345,P <0. 01)呈显著负相关; Cys C水平与WBC(r=0. 299,P=0. 01)、Scr(r=0. 587,P <0. 01)、MELD评分(r=0. 492,P <0. 01)及AKI分期(r=0. 426,P <0. 01)呈显著正相关,与e GFR(r=-0. 558,P <0. 01)呈显著负相关。NGAL单独诊断ACLF相关AKI的AUC为0. 797(95%CI:0. 742～0. 852,P <0. 001),Csy C的AUC为0. 768(95%CI:0. 708～0. 828,P <0. 001),NGAL联合Csy C的AUC为0. 852(95%CI:0. 806～0. 898,P <0. 001)。结论血清NGAL及Cys C水平改变可以反映ACLF相关AKI时的肾功能损伤,两者联合用于ACLF相关AKI的临床诊断价值较高。Objective To explore the diagnostic value of serum neutrophil gelatinase associated lipocalin(NGAL)and and cystain C(CysC)levels in acute-on-chronic liver failure(ACLF)patients with acute kidney injury(AKI).Methods A total of 245 patients with ACLF,who were admitted to our hospital from May 2013 to May 2016,were divided into AKI group(n=112)and non-AKI group(n=133)according to the presence of AKI.The general condition of the patients and routine laboratory parameters were recorded,and serum NGAL and CysC levels were measured by enzyme-linked immunosorbent assay.The correlation between NGAL and CysC levels and clinical indicators,and the diagnostic efficacy of ROC curve indicators were analyzed.Results As compared with those in non-AKI group,the NGAL levels[(83.35±22.89)vs(57.03±20.93)ng/ml,P<0.01]and CysC levels[(1.55±0.64)vs(0.98±0.46)μg/dl,P<0.01]were higher in AKI group.In AKI group,NGAL levels were positively correlated with sCr(r=0.352,P<0.01),MELD scores(r=0.319,P=0.01),CysC(r=0.558,P<0.01),and AKI staging(r=0.605,P<0.001),but negatively correlated with eGFR(r=-0.345,P<0.01).CysC level had a significantly positive correlation with WBC(r=0.299,P=0.01),sCr(r=0.587,P<0.001),MELD scores(r=0.492,P<0.01)and AKI staging(r=0.426,P<0.01),and a significantly negative correlation with eGFR(r=-0.558,P<0.01).In the diagnosis of ACLF-related AKI,the AUC of NGAL alone was 0.797(95%CI:0.742~0.852,P<0.01),that of CsyC was 0.768(95%CI:0.708~0.828,P<0.01),and that of NGAL combined with CsyC was 0.852(95%CI:0.806 to 0.898,P<0.01).Conclusion The changes in serum NGAL and CysC levels may reflect renal function impairment in patients with ACLF-related AKI,and the combination of the two is clinically valuable for the diagnosis of the disease.

关 键 词：慢加急性肝衰竭 急性肾损伤 中性粒细胞明胶酶相关载脂蛋白 半胱氨酸蛋白酶抑制剂C 

分 类 号：R575.3[医药卫生—消化系统]