血清中性粒细胞明胶酶相关脂质运载蛋白在老年急性肾损伤高风险患者的预测价值  

Predictive value of serum neutrophil gelatinase-associated lipocalin for acute kidney injury in high-risk elderly patients

作　　者：郭露露 高飞 张涛[1] 赵卫红 Guo Lulu;Gao Fei;Zhang Tao;Zhao Weihong(Division of Nephrology,Department of Geriatrics of The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院老年肾科,南京210029

出　　处：《中华老年医学杂志》2023年第3期316-321,共6页Chinese Journal of Geriatrics

基　　金：江苏省干部保健科研课题(BJ19018)。

摘　　要：目的 分析中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在老年急性肾损伤(AKI)高风险患者的预测价值。方法 回顾性研究,收集2018年1月至2019年10月南京医科大学第一附属医院老年医学科年龄大于65岁患者183例,患者至少合并1个危险因素,评估NGAL对高风险患者AKI预测的诊断效果。根据患者初始血清肌酐(SCr)和基础肾小球滤过率(eGFR),分为CKD组和非CKD组。通过确定受试者曲线(AuROC)下的面积来确定老年急性肾损伤高风险患者最佳诊断阈值。使用单变量和独立预测因子多因素回归分析评估AKI的风险。结果 AKI组血清NGAL水平高于非AKI组[702.5μg/L(499.2,813.2)比233.9μg/L(147.2,315.7),Z=8.002,P<0.001]。CKD患者中,AKI组血清NGAL高于非AKI组[1033μg/L(845.5,1447)比288.2μg/L(221.4,423.3),Z=4.867,P<0.001]。在所有患者中,包含4个变量的模型3比模型0、1和2显示出更好的AKI预测能力(R2=0.743,P<0.001)。在CKD组中,血清NGAL预测AKI的AuROC高于血清光抑素C(CYS-C)组,而非CKD组则相反,血清NGAL预测AKI的AuROC低于CYS-C。结论 血清NGAL可作为预测老年人群高危风险患者AKI的有用生物标志物,特别在合并CKD的患者中,NGAL对AKI的预测价值优于传统指标。Objective To analyze the predictive value of neutrophil gelatinase-associated lipocalin(NGAL)in high-risk elderly patients with acute kidney injury(AKI).Methods A retrospective study was conducted to collect 183 patients over 65 years old in the Department of Geriatrics,the First Affiliated Hospital of Nanjing Medical University from January 2018 to October 2019.The patients were combined with at least one risk factor.The diagnostic effect of NGAL for AKI prediction in high-risk patients was evaluated.According to the initial serum creatinine(SCr)and basic glomerular filtration rate(eGFR),the patients were divided into chronic kidney disease(CKD)group and non-CKD group.The optimal diagnostic threshold for A-on-C is determined by determining the area under the subject curve(AuROC).Univariate and independent predictors multivariate regression analysis was used to assess the risk of AKI.Results The serum NGAL(NGAL)level in AKI group was higher than that in non-AKI group[702.5μg/L(499.2,813.2)vs.233.9μg/L(147.2,315.7),Z=8.002,P<0.001].In CKD patients,serum NGAL in AKI group was higher than that in non-AKI group[1033μg/L(845.5,1447)vs.288.2μg/L(221.4,423.3),Z=4.867,P<0.001].In all patients,model 3 with four variables showed better AKI prediction ability than model 0,1 and 2(R2=0.743,P<0.001).In the CKD group,the AuROC of serum NGAL for AKI prediction was larger than that of CYS-C group,whereas in the non-CKD group,the AuROC of serum NGAL for AKI prediction was smaller than that of CYS-C group.Conclusions Serum NGAL may serve as a useful biomarker for AKI prediction in AKI high-risk elderly patients.Especially in patients with CKD,Serum NGAL has a better predictive value for AKI than traditional indicators.

关 键 词：中性粒细胞明胶酶相关脂质运载蛋白 急性肾损伤 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学]