血清和尿中性粒细胞明胶酶相关脂蛋白对急性心力衰竭短期预后的预测价值  

Predictive value of serum and urinary neutrophil gelatinase-associated lipoproteins in short-term prognosis of acute heart failure

作　　者：王秋艳[1] 候剑飞 许巧凤[1] 首金梁[1] WANG Qiuyan;HOU Jianfei;XU Qiaofeng;SHOU Jinliang(Chenzhou First People’s Hospital,Chenzhou Hunan 423000,China)

机构地区：[1]郴州市第一人民医院,湖南郴州423000

出　　处：《新疆医科大学学报》2022年第10期1161-1167,共7页Journal of Xinjiang Medical University

基　　金：湖南省卫生计生委科研计划课题项目(B2016203)。

摘　　要：目的探究血清中性粒细胞明胶酶相关脂蛋白(sNGAL)及尿NGAL(uNGAL)与急性心力衰竭(AHF)患者短期预后的关系。方法选取2018年9月至2020年12月期间心脏加强监护病房(CICU)的AHF患者202例,根据出院后60 d内有无发生终点事件将AHF患者分为短期预后良好组(n=164)及预后不良组(n=38),比较两组患者入院时及峰值sNGAL、uNGAL以及血清肌酐(sCr)的水平,采用单因素及多因素Logistic回归分析法分析sNGAL、uNGAL、sCr水平与患者短期预后结局关系,采用受试者工作特征(ROC)曲线分析sNGAL、uNGAL、sCr水平对AHF患者短期预后的预测价值。结果预后良好组的sCr、入院时及峰值sNGAL、uNGAL水平均显著低于预后不良组(P<0.05)。经单因素和多因素Logistic回归分析,峰值uNGAL是AHF患者发生复合终点事件、再次住院治疗及死亡的独立危险因素(P<0.05)。经ROC曲线分析,峰值uNGAL预测复合终点发生AUC为0.919(95%CI:0.881~0.958),特异度和灵敏度分别为89.5%和80.5%;预测死亡AUC为0.915(95%CI:0.874~0.956),特异度和灵敏度分别为93.8%和86.0%,其AUC大于其他指标。结论短期预后不良AHF患者入院时及峰值sNGAL、uNGAL及sCr均较预后良好者升高,并且检测峰值uNGAL对于预测复合及死亡终点事件具有良好的临床价值,且预测效能优于sNGAL和sCr。Objective To investigate the relationship between serum neutrophil gelatinase-associated lipocalin(sNGAL)and urinary NGAL(uNGAL)and short-term prognosis in patients with acute heart failure(AHF).Methods 202 patients with AHF in Cardiac Intensive Care Unit(CICU)from September 2018 to December 2020 were selected.According to the occurrence of end point events within 60 days after discharge from the hospital,the AHF patients were divided into two groups:good short-term prognosis group(n=164)and poor prognosis group(n=38).The levels of sNGAL,uNGAL at admission and the peak,serum creatinine(sCr)were compared between the two groups,and the relationship between the levels of sNGAL,uNGAL and sCr and the short-term outcomes of the patients were analyzed by univariate and multivariateLogisticregression analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of sNGAL,uNGAL and sCr levels in the short-term prognosis of the AHF patients.ResultsThe levels of sNGAL,uNGAL at admission and the peak,sCr in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05).By univariate and multivariateLo-g isticregression analysis,uNGAL at the peak was an independent clinical factor for the occurrence of compound end point,the re-hospitalization end point and death in AHF patients(P<0.05).ByROCcurve analysis,theAUCof uNGAL at the peak for predicting the occurrence of the compound end point was 0.919(95%CI:0.881~0.958),and the specificity and sensitivity were 89.5%and 80.5%,respectively,for predicting the occurrence of deathAUC was 0.915(95%CI:0.874~0.956),and the specificity and sensitivity were 93.8%and 86.0%,respectively,which were better than other indexes.ConclusionThe peak values of sNGAL,uNGAL and sCr were higher in AHF patients than those with good prognosis,and the detection of uNGAL has good clinical value for predicting complex and death end-point events,and the predictive performance is better than sNGAL and sCr.

关 键 词：血清中性粒细胞明胶酶相关脂蛋白 尿中性粒细胞明胶酶相关脂蛋白 血清肌酐 急性心力衰竭 短期预后 

分 类 号：R541.62[医药卫生—心血管疾病]