血清NGAL表达水平对肾移植患者术后肾功能不全的预测价值  

Predictive value of serum NGAL levels in patients with chronic renal insufficiency after renal transplantation

作　　者：付枭枭 赵佳 黄江华 毕红萍 Fu Xiaoxiao;Zhao Jia;Huang Jianghua;Bi Hongping(Department of Laboratory,Nanchong Central Hospital,Nanchong 637000,China;Department of Ultrasound,Nanchong Central Hospital,Nanchong 637000,China;Physical Examination Center,Jiangsu Second Hospital of Traditional Chinese Medicine,Nanjing 210000,China)

机构地区：[1]南充市中心医院检验科,南充637000 [2]南充市中心医院超声科,南充637000 [3]江苏省第二中医院体检中心,南京210000

出　　处：《国际泌尿系统杂志》2024年第3期423-427,共5页International Journal of Urology and Nephrology

基　　金：四川省卫计委科研项目(19PJ232)。

摘　　要：目的:探讨肾移植患者术后血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平变化对慢性肾功能不全的预测价值。方法:回顾性分析2018年5月至2021年5月在南充市中心医院行肾移植的103例患者的临床资料,根据术后随访1年是否发生肾功能不全分为肾功能正常组(54例)和肾功能不全组(49例),采用多因素logistic回归分析肾移植患者术后随访1年发生肾功能不全的独立影响因素,分析术后血清NGAL与患者术后随访1年发生肾功能不全的相关性,绘制预测肾移植患者术后随访1年发生肾功能不全的受试者工作特征(ROC)曲线和决策曲线,验证其预测价值。结果:肾功能不全组患者的年龄、体质量指数(BMI)、三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、血清NGAL以及胱抑素C(Cys C)均高于肾功能正常组(均P<0.05);多因素logistic回归分析结果显示,年龄、TG、LDL以及血清NGAL为肾移植患者随访1年发生肾功能不全的独立影响因素(均P<0.05),其中血清NGAL每增加1 ng/mL,肾移植患者随访1年发生肾功能不全的风险增加1.947倍(OR=2.947,95%CI:1.621~3.945,P<0.001)。ROC曲线分析结果显示,年龄≥50.3岁、TG≥2.0 mmol/L、LDL≥3.2 mmol/L以及术后血清NGAL≥157.1 ng/mL可作为肾移植患者术后随访1年发生肾功能不全的标志,其预测肾移植患者术后随访1年发生肾功能不全的曲线下面积(AUC)分别为0.783(95%CI:0.621~0.845)、0.742(95%CI:0.689~0.791)、0.753(95%CI:0.717~0.811)以及0.882(95%CI:0.811~0.912),而联合预测的AUC最大值为0.945(95%CI:0.919~0.986)。决策曲线分析结果显示,年龄、TG、LDL以及血清NGAL预测肾移植患者术后随访1年发生肾功能不全均具有良好的净收益率。结论:术后血清NGAL水平变化可提前预测肾移植患者术后出现肾功能不全,且预测价值较高,值得临床推广应用。Objective To investigate the predictive value of serum neutrophil gelatinase associated lipid transporter(NGAL)levels in patients with chronic renal insufficiency after renal transplantation.Methods The clinical data of 103 patients who underwent kidney transplantation in Nanchong Central Hospital from May 2018 to May 2021 were retrospectively analyzed.All patients were divided into normal renal function group(54 cases)and renal insufficiency group(49 cases)according to whether renal insufficiency during l-year follow-up after surgery.The general data before surgery and serum NGAL after surgery of donors and recipients between the two groups were compared.Multifactor logistic regression analysis was used to obtain independent predictors of renal insufficiency during 1-year follow-up after renal transplantation,the analysis was focused on the correlation between postoperative serum NGAL and renal insufficiency in patients during l-year follow-up after surgery,the receiver operating characteristics(ROC)curve and decision curve of independent predictors were drawn to predict renal insufficiency in patients during 1-year follow-up after surgery,and to verify their predictive value.Results The age,body mass index(BMI),triglycerides(TG),cholesterol(TC),low-density lipoprotein(LDL),serum NGAL,and cystatin C(Cys C)of patients with renal insufficiency were significantly higher than those of patients in normal renal function(all P<0.05).The results of multivariate logistic regression analysis showed that age,TG,LDL,and serum NGAL were independent influencing factors of the occurrence of renal insufficiency in kidney transplant patients during 1-year follow-up(all P<0.05).The risk of renal insufficiency in kidney transplant patients increased by 1.947 times for every 1 ng/mL increase in serum NGAL(OR=2.947,95%CI:1.621-3.945,P<0.001).ROC analysis results showed that when the age≥50.3 years,TG≥2.0 mmol/L,LDL≥3.2 mmol/L,and postoperative serum NGAL≥157.1 ng/mL,it could be used as a sign of renal insufficiency in renal

关 键 词：肾移植 肾功能不全 中性粒细胞明胶酶相关载脂蛋白 

分 类 号：R699.2[医药卫生—泌尿科学]