目的 探讨血和尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin，NGAL)水平对成人肝移植术后急性肾损伤(acute kidney injury，AKI)的早期诊断价值。方法 收集88例肝移植手术患者手术前后不同时相的血、尿标本，分别测定血肌酐、血NGAL和尿NGAL。根据AKI的诊断标准，将患者分为AKI组和非AKI组，观察两组血肌酐、血NGAL和尿NGAL的动态变化。用受试者工作特征曲线(ROC)评价血NGAL和尿NGAL对AKI的诊断价值。结果 88例中，32例术后发生肾损伤 AKI发生率为36.4％。AKI组术后4 h血NGAL开始显著增高，与非AKI组比较差异有统计学意义(P<0.05)，8 h达高峰，此后保持较高水平;术后4 h尿NGAL较基线值明显上升，与非AKI组比较差异有统计学意义(P<0.05)。AKI组术后4 h血NGAL诊断AKI的ROC曲线下面积为0.88，(0.76～0.97)，以200 ng/ml作为AKI的诊断界限时，敏感性和特异性分别为89％和87％;尿 NGAL的ROC曲线下面积为0.92(0.86～0.97)，以400 ng/ml作为AKI的诊断界限时，敏感性和特异性分别为94％和88％。结论 肝移植手术后4 h的血、尿NGAL水平对AKI具有预测价值，可作为肝移植术后并发AKI患者早期诊断的标记物。
Abstract
Objective To investigate the early diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) on acute kidney injury(AKI) in patients undergoing liver transplantation.Methods Serial blood and urine samples were collected from 88 hospitalized patients undergoing liver transplantation before and after surgery.The concentrations of serum creatinine,serum NGAL and urine NGAL were measured.According to AKI criteria, patients were divided into AKI group and non-AKI group.Dynamic changes of levels of serum creatinine,serum NGAL and urine NGAL in the two groups were observed. The receiver operating characteristic curve CHIVe was used to evaluate the early diagnostic value of serum NGAL and urine NGAL.Results After liver transplantation 32 patients(36.4％) developed AKI.In the AKI group,serum and urine concentration of NGAL at 4h time point was significantly elevated, compared with non-AKI group(P<0.05).The area under the curve of serum NGAL was 0.88(95％CI, 0.76-0.97),the sensitivity was 89％ and specificity was 87％with a cutoff value of 200 ng/ml.For concentration in urine of NGAL at 4h, the area under the curve was 0.92(95％CI,0.86-0.97),the sensitivity was 94％and specificity was 88％ with a cutoff value of 400ng/ml.Conclusions Serum and urine concentrations of NGAL at 4h after liver transplantation ean predict AKI.
关键词
中性粒细胞明胶酶相关脂质运载蛋白 /
肝移植 /
急性肾损伤 /
诊断
Key words
neutrophil gelatinase-associated lipocalin /
liver transplantation /
acute kidney injury /
diagnosis
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参考文献
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基金
武警总医院药圃基金(院内课题):WJ20130047;国家863项目:2012AA021006
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