中性粒细胞明胶酶相关脂质运载蛋白和中性粒细胞与淋巴细胞及血小板比值检测对敌草快中毒老年患者肾损伤的早期预测价值  

The value of neutrophil gelatinase-associated lipocalin and neutrophil-to-lymphocyte and platelet ratio in the early prediction of kidney injury in elderly patients with Diquat poisoning

作　　者：齐洪娜[1] 李佳[1] 肖青勉[1] 朱保月[1] 王维展[1] Qi Hongna;Li Jia;Xiao Qingmian;Zhu Baoyue;Wang Weizhan(Emergency Department,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,衡水053000

出　　处：《中华老年医学杂志》2022年第11期1327-1332,共6页Chinese Journal of Geriatrics

基　　金：河北省卫生健康委员会科学技术研究与发展计划项目(20200404)。

摘　　要：目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和中性粒细胞与淋巴细胞和血小板比值(NLPR)检测对老年敌草快(DQ)中毒患者肾损伤的早期预测价值。方法采用回顾性研究,选择河北医科大学哈励逊国际和平医院急诊重症监护室(EICU)2019年10月至2021年10月收治的老年DQ中毒患者106例作为老年组,将患者分为急性肾损伤组(AKI组)62例和非急性肾损伤组(NAKI组)44例,同时设非老年DQ中毒患者40例为非老年组,患者在入EICU时,取肘静脉血5 ml,检测NGAL、NLPR水平,通过Logistic回归分析老年DQ中毒患者发生AKI的独立危险因素,通过受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估NGAL和NLPR对老年DQ中毒患者发生AKI和预后的预测价值。结果AKI组血NGAL、NLPR水平均明显高于NAKI组[(387.1±46.6)μg/L比(103.5±18.6)μg/L、(13.5±3.4)比(5.3±1.1),t=38.243、15.608,均P<0.001]。Logistic回归分析结果显示,NGAL(OR=1.009、95%CI:1.003~1.015、P<0.001)、NLPR(OR=1.263、95%CI:1.039~1.536、P<0.001)水平升高均是老年DQ中毒患者发生AKI的危险因素。NGAL、NLPR及NGAL+NLPR对AKI预测的ROC曲线下面积分别为0.834、0.803和0.873。NGAL和NLPR对老年DQ中毒患者死亡的预测能力高于肌酐清除率(Ccr),两者联合应用预测死亡风险的敏感度为0.850、特异度0.828、AUC为0.887。结论NGAL和NLPR是老年DQ中毒患者发生AKI的独立危险因素,老年DQ中毒患者血NGAL、NLPR联合检测预测AKI和预后的价值更高。Objective To explore the value of neutrophil gelatinase-associated lipocalin(NGAL)and neutrophil-to-lymphocyte and platelet ratio(NLPR)for early prediction of kidney injury with Diquat(DQ)poisoning in elderly patients.Methods In this retrospective study,a total of 106 elderly patients with DQ poisoning treated in the Emergency Intensive Care Unit(EICU)of Harrison International Peace Hospital Affiliated to Hebei Medical University between October 2019 and October 2021 were divided into an acute kidney injury group(AKI group,n=62)and a non-acute kidney injury group(NAKI group,n=44).Meanwhile,40 non-elderly patients with DQ poisoning served as the control group.Samples of 5 ml venous blood were collected from patients admitted to the EICU to measure NGAL and NLPR levels and Logistic regression analysis was conducted to analyze independent risk factors for AKI in elderly DQ poisoning patients.The area under the curve(AUC)was calculated via the receiver operating characteristic(ROC)curve,and the value of NGAL and NLPR for early prediction of AKI in elderly patients with DQ poisoning and patient prognosis was assessed.Results Blood NGAL and NLPR levels in the AKI group were significantly higher than in the NAKI group[(387.1±46.6)μg/L vs.(103.5±18.6)μg/L,(13.5±3.4)vs.(5.3±1.1),t=38.243,15.608,P<0.001 for both].Logistic regression analysis results showed that elevated levels of NGAL(OR=1.009,95%CI:1.003-1.015,P<0.001)and NLPR(OR=1.263,95%CI:1.039-1.536,P<0.001)were risk factors for AKI in elderly patients with DQ poisoning.The areas under the ROC curves of NGAL,NLPR and NGAL+NLPR for AKI prediction were 0.834,0.803 and 0.873 respectively.The predictive power of NGAL and NLPR for the death of elderly patients with DQ poisoning was higher than that of creatinine clearance(Ccr).The sensitivity of the combination of the two to predict the risk of death was 0.850,the specificity was 0.828,and the AUC was 0.887.Conclusions NGAL and NLPR are independent risk factors for the occurrence of AKI in elderly patients with DQ po

关 键 词：敌草快 中毒 脂质蛋白质类 肾损伤 

分 类 号：R595.4[医药卫生—内科学]