尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值

doi:10.3969/j.issn.1006-7795.2015.04.015

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (4): 592-596.doi: 10.3969/j.issn.1006-7795.2015.04.015

尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值

栾海霞, 袁慧, 贺建勋, 马旭, 姚兴荣, 曾小莉, 桂媛, 刘玉磊

首都医科大学附属北京安贞医院检验科北京心肺血管疾病研究所, 北京 100029

收稿日期:2015-06-01 出版日期:2015-08-21 发布日期:2015-07-17
通讯作者: 袁慧 E-mail:18911662931@189.cn
基金资助:
教育部重点实验室开放研究课题(2013XXGB01)。

Value of urinary neutrophil gelatinase-associated lipocalin determined at different time points in early diagnosis of cardiac surgery-associated acute kidney injury

Luan Haixia, Yuan Hui, He Jianxun, Ma Xu, Yao Xingrong, Zeng Xiaoli, Gui Yuan, Liu Yulei

Clinical laboratory, Beijing Anzhen Hospital, Capital Medical University & Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China

Received:2015-06-01 Online:2015-08-21 Published:2015-07-17
Supported by:
This study was supported by the Open Research Subject of Key Laboratory of Ministry of Education(2013XXGB01).

摘要/Abstract

摘要：

目的前瞻性探讨心脏手术患者不同时点尿液中性粒细胞明胶酶相关脂质转运蛋白(urinary neutrophil gelatinase-associated lipocalin,uNGAL)对急性肾损伤(acute kidney injury,AKI)的早期诊断价值。方法将2010年10月至2011年5月在首都医科大学附属北京安贞医院进行心脏手术的111例(男性82例、女性29例)患者纳入本研究。分别收集术前及术后0、3、6、12、24、48、72 h的尿液标本,采用ARCHITECT i2000免疫分析仪进行尿液NGAL的检测。根据2012年改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes,KDIGO)指南提出的AKI诊断标准将患者分为AKI组和非AKI组。结果 AKI的发生率为21.6%(24例)。与非AKI组比较,AKI组术后0 h的uNGAL较非AKI组升高最为显著〔54.20(9.60~452.10) vs 8.95(3.03~24.65),P<0.01〕;6 h的uNGAL也显著高于非AKI组〔35.50(10.60~80.10) vs 12.20(6.30~38.40),P<0.05〕。AKI组术后0 h uNGAL较术前升高倍数显著高于非AKI组(2.72倍vs 1.09倍,P<0.01)。ROC曲线分析显示,术后0h诊断AKI的曲线下面积(95%可信区间)为0.852(0.777~0.926,P<0.01),Cut-off值为28.25 ng/mL时,灵敏度和特异度分别为91.7%和77.4%;术后6h诊断AKI的曲线下面积为0.650(0.500~0.651,P<0.05),Cut-off值为26.50 ng/mL时,灵敏度和特异度分别为50.0%和65.1%;术后0 h与术前uNGAL比值诊断AKI的曲线下面积为0.752(0.642~0.862,P<0.01),Cut-off值为1.95倍时,灵敏度和特异度分别为93.3%和64.5%。结论尿NGAL可作为心脏术后并发AKI的早期诊断标志物;术后0 h测定尿液NGAL是诊断早期AKI的最佳时点。

Abstract:

Objective To prospectively explore the value of urinary neutrophil gelatinase-associated lipocalin(uNGAL) determined at different time points in early diagnosis of cardiac surgery-associated acute kidney injury(AKI). Methods A total of 111 hospitalized patients undergone cardiac surgery were enrolled into this study from October 2011 to May 2012. The urinary samples were collected before cardiac surgery and at 0, 6, 12, 24, 48, 72 h after surgery, and uNGAL was immediately measured by ARCHITECT i2000. According to AKI criteria of Kidney Disease Improving Global Outcomes(KDIGO) clinical practice guidelines on AKI, the subjects were divided into the AKI group and non-AKI group. Results Twenty-four of the 111 patients developed acute kidney injury(21.6%). Compared with non-AKI group, the uNGAL level of AKI group was dramatically increased at 0 h after surgery〔54.20(9.60-452.10) vs 8.95(3.03-24.65), P<0.001〕, and was also significantly higher at 6 h after surgery〔35.50(10.60-80.10) vs 12.20(6.30-38.40), P<0.05〕. The 0h after surgery-to-baseline ratio of uNGAL was significantly higher in AKI group than in non-AKI group(2.72 vs 1.09, P<0.01). The area under the receiver operating characteristic(ROC) curve, the cutoff value, the sensitivity and specificity for 0 h uNGAL after surgery were 0.852(0.777-0.926, P<0.001), 28.25 ng/mL, 91.7% and 77.4%, for 6 h uNGAL after surgery were 0.650(0.500-0.651, P<0.026), 26.50 ng/mL, 50.0% and 65.1%, for 0 h uNGAL after surgery-to-baseline ratio were 0.752(0.642-0.862, P=0.001), 1.95, 93.3% and 64.5%, respectively. Conclusion The uNGAL can be used as an early biomarker for prediction of cardiac surgery-associated acute kidney injury(AKI). The uNGAL 0 h after surgery was the best point for diagnosis of AKI.

Key words: neutrophil gelatinase-associated lipocalin, cardiac surgery, acute kidney injury, urinary

中图分类号:

R692

栾海霞, 袁慧, 贺建勋, 马旭, 姚兴荣, 曾小莉, 桂媛, 刘玉磊. 尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值[J]. 首都医科大学学报, 2015, 36(4): 592-596.

Luan Haixia, Yuan Hui, He Jianxun, Ma Xu, Yao Xingrong, Zeng Xiaoli, Gui Yuan, Liu Yulei. Value of urinary neutrophil gelatinase-associated lipocalin determined at different time points in early diagnosis of cardiac surgery-associated acute kidney injury[J]. Journal of Capital Medical University, 2015, 36(4): 592-596.

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尿NGAL不同时点浓度变化在心脏术后急性肾损伤的早期诊断价值

Value of urinary neutrophil gelatinase-associated lipocalin determined at different time points in early diagnosis of cardiac surgery-associated acute kidney injury

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