尿液NGAL、KIM-1、TFF3联合检测对肝硬化患者急性肾小管坏死的诊断价值  

Diagnostic value of combined detection of urine NGAL,KIM-1,and TFF3 in acute tubular necrosis associated 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19期808-815,共8页World Chinese Journal of Digestology

摘　　要：背景急性肾损伤(acute kidney injury,AKI)是失代偿期肝硬化患者常见的并发症,临床死亡率高且预后较差,其中急性肾小管坏死(acute tubular necrosis,ATN)预后最差,及时准确地识别ATN是临床难以解决的问题,既往研究显示,尿液中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、三叶因子3(trefoil factor 3,TFF3)及肾损伤因子-1(kidney injury molecule-1,KIM-1)对于肝硬化中ATN与其他类型的AKI有潜在的鉴别诊断价值,但诊断效能较低,仍不能进入临床应用,需进一步探究指标间联合检测能否提升生物标志物对于肝硬化合并ATN的诊断效能.目的分析尿NGAL、尿KIM-1、尿TFF3及两两指标间联合检测在肝硬化合并AKI患者中对于ATN的鉴别诊断价值,同时对尿NGAL等指标对于ATN鉴别诊断的临界值行进一步研究.方法选取失代偿期肝硬化患者190例,其中合并AKI患者108例,根据AKI病因分成不同亚组,包括33例肾前性氮质血症,27例肝肾综合征急性肾损伤型及48例ATN,探究尿NGAL、尿TFF3、尿KIM-1及指标间两两联合在肝硬化合并AKI患者中对于ATN的鉴别诊断价值.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0.902,诊断临界值为271.8 ug/g Cr时,敏感度为81.3%,特异性为85.0%.指标联合可提高鉴别诊断能力,其中尿NGAL联合尿TFF3的诊断能力最强(AUC=0.933,敏感度为85.4%,特异性为88.3%).结论尿NGAL、尿KIM-1、尿TFF3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,2项指标间的联合检测可进一步提升诊断效能,值得进一步研究及临床推广.BACKGROUND Acute kidney injury(AKI)is a common complication of decompensated cirrhosis with high clinical mortality and poor prognosis,of which acute tubular necrosis(ATN)has the worst prognosis.Timely and accurate identification of ATN is a difficult problem to solve clinically.Previous studies have shown that urinary neutrophil gelatinase-associated lipocalin(NGAL),trefoil factor 3(TFF3),and kidney injury molecule-1(KIM-1)have potential value in the differential diagnosis of ATN and other types of AKI in patients with liver cirrhosis,but they still cannot be applied in clinical practice due to the low diagnostic efficacy.It is necessary to further explore whether the combined detection of the indicators can improve their diagnostic efficacy for ATN associated with cirrhosis.AIM To analyze the value of urinary NGAL,KIM-1,and TFF3,either alone or in combination,in the differential diagnosis of ATN in patients with cirrhosis complicated with AKI,and explore the cut-off values of urinary NGAL and other indicators in the differential diagnosis of ATN.METHODS A total of 190 patients with decompensated cirrhosis were selected,including 108 patients with AKI.They were divided into different subgroups according to the cause of AKI,including 33 cases of prerenal azotemia,27 cases of acute renal injury with hepatorenal syndrome,and 48 cases of ATN.The value of urinary NGAL,TFF3,and KIM-1,either alone or in combination,in the differential diagnosis of ATN in patients with cirrhosis complicated with AKI was then assessed.RESULTS Urinary NGAL was of great value in the differential diagnosis of ATN in patients with cirrhosis complicated with AKI.The area under the curve(AUC)was 0.902;when the diagnostic threshold was 271.8μg/g Cr,the sensitivity was 81.3%and the specificity was 85.0%.The combination of two biomarkers could improve the efficacy of differential diagnosis,with the diagnostic perfomance of urinary NGAL combined with urinary TFF3 being the best(AUC=0.933,sensitivity 85.4%,specificity 88.3%).CONCLUSION Urinary NGA

关 键 词：肝硬化 急性肾损伤 NGAL TFF3 KIM-1 联合检测 急性肾小管坏死 

分 类 号：R692[医药卫生—泌尿科学]