肝硬化合并急性肾损伤患者尿NGAL、L-FABP变化及意义  

Changes and Significance of Urinary NGAL and L-FABP in Patients with Liver Cirrhosis Complicated with Acute Kidney Injury

作　　者：潘俊娣[1] 叶斌[1] 戴木根[1] 李巧媚 徐跃元 PAN Jun-di;YE Bin;DAI Mu-gen(Department of Gastroenterology, Lishui Central Hospital ( Lishui Zhejiang,323000) China)

机构地区：[1]丽水市中心医院消化内科,浙江丽水323000

出　　处：《中西医结合肝病杂志》2019年第1期29-32,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：浙江省中医药科研基金项目(No.2015ZA226)

摘　　要：目的:探讨肝硬化合并急性肾损伤患者尿中性粒细胞明胶相关脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)变化及意义。方法:本院肝硬化患者198例,依据是否合并急性肾损伤分为急性肾损伤(AKI)组100例,非急性肾损伤(非AKI)组98例,选择我院门诊同期健康体检者96例作为对照组,测定两组尿NGAL、L-FABP水平以及24h蛋白尿定量、GFR、血肌酐水平。结果:非AKI组、AKI组NGAL、L-FABP表达水平高于对照组,AKI组NGAL、L-FABP表达水平高于非AKI组(P<0.01);AKI 2期、3期NGAL、L-FABP表达水平高于AKI 1期,AKI 3期NGAL、L-FABP表达水平高于AKI 2期(P<0.01);入院12h、入院24h、入院48h NGAL、L-FABP表达水平高于入院时,入院24h、入院48h NGAL、L-FABP表达水平高于入院12h,入院48h NGAL、L-FABP表达水平高于入院24h(P<0.01);非AKI组、AKI组24h蛋白尿定量、血肌酐水平高于对照组,GFR水平低于对照组,AKI组24h蛋白尿定量、血肌酐水平高于非AKI组,GFR水平低于非AKI组(P<0.01);NGAL、L-FABP与24h蛋白尿定量、血肌酐正相关关系明显,与GFR负相关关系明显(P<0.01);高水平的NGAL、L-FABP以及低水平的GFR为肝硬化合并急性肾损伤发生的危险因素(P<0.05);NGAL、L-FABP两者的AUC相近,皆小于GFR,NGAL、L-FABP诊断肝硬化合并急性肾损伤的灵敏度、特异度相近(P>0.05),皆小于GFR(P<0.01)。结论:肝硬化合并急性肾损伤患者尿NGAL、L-FABP水平明显升高,其与肾功能分级、肾损伤程度正相关关系明显;高水平的NGAL、L-FABP以及低水平的GFR均为肝硬化合并急性肾损伤的危险因素;NGAL、L-FABP诊断肝硬化合并急性肾损伤具有较高的灵敏度、特异度,可作为判定肝硬化合并急性肾损伤的生物学标志物,值得在临床上推广应用。Objective:To investigate the changes and significance of urinary neutrophil gelatinase-associated lipid transporter(NGAL) and hepatic fatty acid binding protein(L-FABP) in patients with liver cirrhosis complicated with acute kidney injury.Methods:One hundred and ninety-eight patients with liver cirrhosis treated in our hospital were divided into groups according to the presence or absence of acute kidney injury,namely,AKI group with 100 cases and non-AKI group with 98 cases.Another 96 healthy examinees were selected as control group.The levels of urinary NGAL,L-FABP,24 h proteinuria,GFR,and serum creatinine were measured.Results:The expression levels of NGAL and L-FABP of three groups in a descending order were AKI group,non-AKI group and control group(P<0.01).The expression levels of NKI and L-FABP among AKI patients with different stages in an ascending order were stage I,stage II and stage III(P<0.01).The expression levels of NGAL and L-FABP were increased with the admission time,so the levels at the post-admission 48 h were higher than those at the pre-admission,post-admission 12 h and 24 h(P<0.01).The levels of 24 h proteinuria and serum creatinine of three groups in an ascending order were control group,non-AKI group and AKI group(P<0.01).The GFR level among three groups in an ascending order were AKI group,non-AKI group and control group(P<0.01).NGAL and L-FABP were positively correlated with 24 h albuminuria and serum creatinine,while were negatively correlated with GFR(P<0.01).High levels of NGAL,L-FABP and low levels of GFR were risk factors for the liver cirrhosis with acute kidney injury(P<0.05).The AUC of both NGAL and L-FABP were similar,suggesting that the sensitivity and specificity of diagnosis of liver cirrhosis combined with acute kidney injury were similar(P>0.05),which were lower than those of the GFR(P<0.01).Conclusion:Patients with liver cirrhosis complicated with acute kidney injury have higher levels of urinary NGAL and L-FABP,which are positively correlated with the grade of renal functi

关 键 词：肝硬化合并急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 肝型脂肪酸结合蛋白 

分 类 号：R692[医药卫生—泌尿科学] R575.2[医药卫生—外科学]