NGAL尿血比值在肝硬化急性肾损伤中的鉴别诊断价值  

Role of urine/serum NGAL ratio in differential diagnosis of acute kidney injury in patients with cirrhosis

作　　者：龚艳清 赵莹 贾艳会[2] 李熳[1] 江勇[1] Yan-Qing Gong;Ying Zhao;Yan-Hui Jia;Man Li;Yong Jiang(Department of Gastroenterology,The Second Hospital of Tianjin Medical University,Tianjin 300211,China;Laboratory Department,Tianjin Third Central Hospital,Tianjin 300100,China)

机构地区：[1]天津医科大学第二医院消化内科,天津市300211 [2]天津市第三中心医院检验科,天津市300100

出　　处：《世界华人消化杂志》2023年第15期630-637,共8页World Chinese Journal of Digestology

摘　　要：背景中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)在肝硬化合并急性肾损伤(acute kidney injury,AKI)患者中对于急性肾小管坏死(acute tubular necrosis,ATN)与其他类型的AKI有重要的鉴别诊断价值,但血NGAL与尿NGAL直接相关,现有研究中对于NGAL尿血比值在ATN的鉴别诊断中的作用的研究很少,本试验意在评估其比值的临床作用.目的分析血尿NGAL及其尿血比值在肝硬化合并AKI患者中对于ATN的鉴别诊断价值.方法选取失代偿期肝硬化患者180例,其中合并AKI患者98例,根据AKI病因分成不同亚组,包括33例肾前性氮质血症,25例肝肾综合征急性肾损伤型及40例ATN,探讨血尿NGAL及其尿血比值在不同类型AKI中鉴别作用.结果尿NGAL对于肝硬化合并AKI患者中ATN的鉴别诊断价值较高,受试者工作曲线下面积(area under the curve,AUC)是0.964,诊断临界值为271.35 ng/mL时,敏感度为87.5%,特异性为96.6%.NGAL尿血比值对于ATN诊断价值也较高,AUC为0.953,诊断临界值在2.96时,敏感度为92.5%,特异性为91.4%.结论尿NGAL和NGAL尿血比值对于鉴别肝硬化合并AKI患者中ATN与其他类型AKI有重要价值,值得进一步研究及临床推广.BACKGROUND Neutrophil gelatinase-associated lipocalin(NGAL)can be used for the differential diagnosis of acute kidney necrosis(ATN)and other types of acute kidney injury(AKI)in patients with liver cirrhosis complicated with AKI.However,serum NGAL is directly related to urine NGAL,and there are few existing studies on the role of urine/serum NGAL ratio in the differential diagnosis of ATN.AIM To assess the significance of serum and urine NGAL as well as urine/serum NGAL ratio in differentiating ATN from other types of AKI in cirrhosis.METHODS A total of 180 patients with decompensated cirrhosis were included in the study,of whom 98 were complicated with AKI.According to the etiology of AKI,there were 33 patients with prerenal azotemia,25 with hepatorenal syndrome-AKI,and 40 with ATN.The patients were divided into different subgroups to assess the value of NGAL in differentiating the types of AKI.RESULTS Urine NGAL and urine/serum NGAL ratio showed signi-ficant value in the differential diagnosis of ATN in patients with liver cirrhosis.At an optimal cut-off of 271.35 ng/mL,urine NGAL distinguished ATN from other types of AKI(area under the cuve[AUC]=0.964;sensitivity,87.5%;specificity,96.6%).As well,at an optimal cut-off of 2.96,urine/serum NGAL ratio could also distinguish ATN from other types of AKI(AUC=0.953,sensitivity 92.5%and specificity 91.4%).CONCLUSION Urine NGAL and urine/serum NGAL ratio have significant value in the differential diagnosis of ATN and other types of AKI in patients with liver cirrhosis,which is worthy of further study and clinical promotion.

关 键 词：肝硬化 急性肾损伤 NGAL 尿血比值 鉴别诊断 急性肾小管坏死 

分 类 号：R575.2[医药卫生—消化系统] R692[医药卫生—内科学]