尿中性粒细胞明胶酶相关脂质运载蛋白和胱抑素C在早产儿败血症合并急性肾损伤中的诊断价值  

The value of urinary neutrophil gelatinase-associated lipocalin and cystatin C in clinical diagnosis of sepsis with acute kidney injury in preterm infants

作　　者：张丽颖 许婧[2] 刘晓萌 李冬 Zhang Liying;Xu Jing;Liu Xiaomeng;Li Dong(Department of Neonatal Intensive Care Unit,Dalian Women and Children′s Medical Group,Dalian116037,China;Dalian Medical University,Dalian 116044,China)

机构地区：[1]大连市妇女儿童医疗中心(集团)新生儿科,大连116037 [2]大连医科大学,大连116044

出　　处：《中国医师进修杂志》2022年第5期392-396,共5页Chinese Journal of Postgraduates of Medicine

基　　金：2018年大连市科技创新基金项目(2018J13SN106)。

摘　　要：目的探究尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和胱抑素C(Cys C)的检测在早产儿败血症合并急性肾损伤(AKI)中的诊断价值。方法采用病例对照研究,根据纳入标准选取2018年11月至2021年10月入住大连市妇女儿童医疗中心NICU诊断晚发型败血症(LOS)的早产儿64例,按照是否发生AKI分为败血症AKI组24例,败血症非AKI组40例。检测生后1 d及发生败血症1 d的血肌酐,尿NGAL、Cys C,尿量。采用t检验进行统计学分析,绘制受试者工作特征(ROC)曲线分析血肌酐、尿NGAL及Cys C对败血症合并AKI的诊断价值。结果败血症AKI组早产儿血肌酐、尿NGAL及Cys C水平均明显高于败血症非AKI组[(53.667±20.040)μmol/L比(35.975±9.048)μmol/L、(1.613±0.405)μg/L比(0.839±0.258)μg/L、(39.524±11.619)μg/L比(21.778±3.302)μg/L],差异有统计学意义(P<0.01)。ROC曲线比较显示,败血症合并AKI时,尿NGAL及Cys C的曲线下面积(0.946,0.965)、灵敏度(97.5%,100.0%)及特异度(75.0%,79.2%)均明显高于血肌酐,差异有统计学意义(P<0.05),具有良好的诊断效能。结论尿NGAL及Cys C灵敏度较高,可作为早产儿败血症合并AKI早期诊断的生物学指标。Objective To investigate the clinical diagnosis value of urinary neutrophil gelatinase-associated lipocalin(NGAL)and Cystatin C(Cys C)of late onset sepsis(LOS)with acute kidney injury(AKI)in preterm infants.Methods A case-control study was used among preterm infants diagnosed with LOS and admitted to the NICU of Dalian Women and Children′s Medical Group from November 2018 to October 2021,including 24 cases of sepsis AKI group and 40 cases of sepsis non-AKI group.The blood creatinine,urine NGAL,Cys C levels and urine volume were measured at 1 d after birth and 1 d after sepsis.The t-test was used for statistical analysis,and the receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic value of blood creatinine,urinary NGAL and Cys C in LOS combined with AKI.Results Blood creatinine,urinary NGAL and Cys C levels were significantly higher in the sepsis AKI group than that in the sepsis non-AKI group:(53.667±20.040)μmol/L vs.(35.975±9.048)μmol/L,(1.613±0.405)μg/L vs.(0.839±0.258)μg/L,(39.524±11.619)μg/L vs.(21.778±3.302)μg/L(P<0.01).Comparison of ROC curves showed that in sepsis AKI group the AUC(0.946 and 0.965,respectively),sensitivity(97.5%and 100.0%,respectively)and specificity(75.0%and 79.2%,respectively)of the urinary NGAL and Cys C levels were higher in than those of creatinine level(AUC 0.771,sensitivity 95.0%,specificity 62.5%),with statistically significant differences(P<0.05).Conclusions Urinary NGAL and Cys C are more sensitive than creatinine and can be used as biological indicators for the early diagnosis of sepsis with AKI in preterm infants.

关 键 词：败血症 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 胱抑素C 早产儿 

分 类 号：R722.6[医药卫生—儿科]