血清NGAL、KIM-1、ACTH对肾结石患者微通路经皮肾镜碎石术后发生肾功能损伤的预测价值  

Predictive value of serum NGAL,KIM-1 and ACTH for renal function injury after microaccess percutaneous nephrolithotomy in patients with kidney stones

作　　者：牛忠涛 袁宏毅 郝强 李娜[1] 乔玉华[1] NIU Zhongtao;YUAN Hongyi;HAO Qiang;LI Na;QIAO Yuhua(Department of Urology,the Second Affiliated Hospital of Xingtai Medical College,Xingtai,Hebei 054000,China;Department of Urology,Xingtai Third Hospital,Xingtai,Hebei 054000,China)

机构地区：[1]邢台医学高等专科学校第二附属医院泌尿外科,河北邢台054000 [2]邢台市第三医院泌尿外科,河北邢台054000

出　　处：《检验医学与临床》2025年第8期1039-1044,共6页Laboratory Medicine and Clinic

基　　金：河北省邢台市重点研发计划项目(2021ZC182)。

摘　　要：目的 探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)、促肾上腺皮质激素(ACTH)对肾结石患者微通道经皮肾镜碎石术后发生肾功能损伤的预测价值。方法 选取2021年4月至2023年8月邢台医学高等专科学校第二附属医院收治的260例肾结石患者作为研究对象,根据是否发生肾功能损伤分为肾功能损伤组和肾功能未损伤组。比较2组手术前后血清NGAL、KIM-1、ACTH水平。采用Pearson相关分析肾结石患者术后12、24 h血清NGAL、KIM-1、ACTH水平与术后48 h血肌酐水平的相关性。采用多因素Logistic回归分析肾结石患者微通路经皮肾镜碎石术后发生肾功能损伤的影响因素。绘制受试者工作特征(ROC)曲线分析血清NGAL、KIM-1、ACTH对肾结石患者微通路经皮肾镜碎石术后发生肾功能损伤的预测效能。结果 重复测量方差分析结果显示,2组手术前后血清NGAL、KIM-1、ACTH水平存在组间、时间及交互效应(P<0.05)。术后24、48 h 2组患者血清NGAL、KIM-1和ACTH水平明显高于术前和术后12 h(P<0.05),且术后12 h高于术前(P<0.05),多变量方差分析结果显示,肾功能损伤组患者术后12、24 h血清NGAL、KIM-1和ACTH水平明显高于肾功能未损伤组(P<0.05)。Pearson相关分析结果显示,260例肾结石患者术后12 h血清NGAL、KIM-1、ACTH水平与术后48 h血肌酐水平呈正相关(r=0.857、0.890、 0.671,P<0.001);术后24 h血清NGAL、KIM-1、ACTH水平与术后48 h血肌酐水平呈正相关(r=0.753、 0.634、 0.654,P<0.001)。多因素Logistic回归分析结果显示,术后12、24 h血清NGAL、KIM-1、ACTH水平升高是肾结石患者微通路经皮肾镜碎石术后肾功能损伤的危险因素(P<0.05)。ROC曲线分析结果显示,术后12、24 h血清NGAL、KIM-1、ACTH联合预测肾结石患者微通路经皮肾镜碎石术后发生肾功能损伤的曲线下面积为0.955。结论 肾结石患者微通路经皮肾镜碎石术后12、24 h血清NObjective To investigate the predictive value of serum neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule-1(KIM-1)and adrenocorticotropic hormone(ACTH)for renal injury after microaccess percutaneous nephrolithotomy(MPCNL)in patients with kidney stones.Methods A total of 260 patients with kidney stones admitted to the Second Affiliated Hospital of Xingtai Medical College from April 2021 to August 2023 were selected as the research subjects.According to whether renal function injury occurred,they were divided into renal function injury group and non-renal function injury group.The serum levels of NGAL,KIM-1 and ACTH were compared between the two groups before and after operation.Pearson correlation analysis was used to analyze the correlation between serum NGAL,KIM-1,ACTH levels at 12 and 24 h after operation and serum creatinine level at 48 h after operation in patients with kidney stones.Multivariate Logistic regression was used to analyze the influencing factors of renal function injury after MPCNL in patients with kidney stones.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of serum NGAL,KIM-1 and ACTH for renal function injury after MPCNL in patients with kidney stones.Results Repeated measures analysis of variance showed that there were inter-group,time and interaction effects in serum NGAL,KIM-1 and ACTH levels before and after operation in the two groups(P<0.05).The levels of serum NGAL,KIM-1 and ACTH in the two groups at 24 h and 48 h after operation were significantly higher than those before operation and 12 h after operation(P<0.05),and the levels at 12 h after operation were higher than those before operation(P<0.05).The levels of serum NGAL,KIM-1 and ACTH in patients with renal function injury at 12 and 24 h after operation were significantly higher than those in patients without renal function injury(P<0.05).The results of Pearson correlation analysis showed that the serum NGAL,KIM-1,ACTH levels of 260 patients with kidney stone at 12

关 键 词：中性粒细胞明胶酶相关脂质运载蛋白 肾损伤分子-1 促肾上腺皮质激素 肾结石 微通道经皮肾镜碎石术 肾功能 

分 类 号：R446.11[医药卫生—诊断学] R699.2[医药卫生—临床医学]