血浆NGAL水平对ST段抬高型心肌梗死患者直接PCI急性肾损伤的早期预测价值  

Early predictive value of plasma neutrophil gelatinase-associated lipocalin levels for acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：汤振 金晓萍 金国珍 单守杰[3] TANG Zhen;JIN Xiaoping;JING Guozhen;SHAN Shoujie(Department of Cardiology,Suqian Infectious Disease Hospital,Suqian,Jiangsu,233100,China;Department of Cardiology,Suqian First Hospital;Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University)

机构地区：[1]宿迁市传染病医院心内科,江苏宿迁233100 [2]宿迁市第一人民医院心内科 [3]南京医科大学附属南京医院心内科

出　　处：《临床心血管病杂志》2025年第1期39-43,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨血浆中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入术(PCI)中急性肾损伤(AKI)的早期预测价值。方法:连续纳入2017年10月—2019年5月在南京医科大学附属南京医院接受直接PCI治疗的450例STEMI患者。PCI前(0 h)和PCI后24 h测量血浆NGAL水平。AKI根据术后血清肌酐水平升高KDIGO标准定义。应用受试者工作特征曲线(ROC)确定血浆NGAL水平预测AKI的截断值、灵敏度和特异度。结果:总体AKI发生率为14.2%。和没有发生AKI的患者相比,AKI患者0 h时[(89.6±33.9)ng/mL vs(139.5±38.4)ng/mL,P<0.001]和24 h时[(93.7±35.2)ng/mL vs(167.2±45.3)ng/mL,P<0.001]NGAL水平明显升高。Logistic回归显示,NGAL水平0 h(OR=1.056,95%CI:1.012~1.324,P=0.006)和术后24 h(OR=1.132,95%CI:1.043~1.419,P=0.03)与发生AKI独立相关。ROC曲线显示,NGAL 0 h为124.9 ng/mL时,预测AKI的灵敏度为87.5%,特异度为89.5%(AUC=0.881,95%CI:0.801~0.961,P<0.001)。结论:NGAL水平升高提示肾小管损伤,与接受直接PCI的STEMI患者发生AKI独立相关。Objective To investigate the early predictive value of plasma neutrophil gelatinase-associated lipocalin(NGAL)levels for acute kidney injury(AKI)in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI).Methods A total of 450 consecutive patients with STEMI undergoing primary PCI at the Department of Cardiology,Nanjing First Hospital,were enrolled between October 2017 and May 2019.Plasma NGAL levels were measured prior to PCI(0 h)and 24 h afterward.AKI was defined according to the KDIGO criteria,which is based on serum creatinine increase.Receiver-operating characteristic(ROC)methods were used to identify the cut-off value,sensitivity,and specificity of plasma NGAL levels for predicting AKI.Results The overall AKI incidence was 14.2%.NGAL levels were significantly higher in patients with AKI compared to those without AKI,at both 0 h[(89.6±33.9)ng/mL vs(139.5±38.4)ng/mL,P<0.001]and 24 h[(93.7±35.2)ng/mL vs(167.2±45.3)ng/mL,P<0.001].Logistic regression analysis showed that NGAL levels were independently associated with AKI at 0 h(OR=1.056,95%CI:1.012-1.324,P=0.006)and 24 h(OR=1.132,95%CI:1.043-1.419,P=0.03).ROC curve analysis revealed the cut-off value of NGAL predicted AKI was determined as 124.9 ng/mL with a sensitivity of 87.5%and a specificity of 89.5%(AUC=0.881,95%CI:0.801-0.961,P<0.001).Conclusion Elevated NGAL levels suggest renal tubular damage,and are independently associated with AKI in STEMI patients undergoing primary PCI.

关 键 词：中性粒细胞明胶酶相关脂质运载蛋白 急性肾损伤 ST段抬高型心肌梗死 经皮冠状动脉介入 

分 类 号：R542.2[医药卫生—心血管疾病]