心脏术后尿中性粒细胞明胶酶相关脂质运载蛋白和白细胞介素18与急性肾损伤的关系

目的 探讨接受体外循环心脏手术患者尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和尿白细胞介素18（IL-18）与急性肾损伤（AKI）的关系。 方法 根据AKI的诊断标准，将33例体外循环心脏手术的患者分为AKI组及非AKI组，分别留取术前及术后不同时间点的血液和尿液标本，测定Scr、尿NGAL和IL-18水平。 结果 33例中有9例发生AKI，发生率为27.27%。AKI组Scr升高峰值出现在12～48 h内。与术前相比， AKI组术后2 h、4 h尿NGAL及IL-18水平升高，差异有统计学意义（P < 0.01）。与非AKI组比较，AKI组术后各时间点的尿NGAL水平、术后2 h及4 h的尿IL-18水平都较高，差异有统计学意义（P < 0.01）。经尿肌酐（Ucr）校正后，相应时间点的NGAL/Ucr和IL-18/Ucr差异仍有统计学意义（P < 0.01）。术后2 h尿NGAL和尿NGAL/Ucr的界定（cutoff） 值分别在250 µg/L和250 µg/mmol时；术后2 h尿IL-18和尿IL-18/Ucr的界定值分别在1800 ng/L和1800 ng/mmol时，体现出较好的敏感性和特异性。 AKI组术后12 h Scr水平与术后2 h尿NGAL水平呈正相关（r = 0.638，P < 0.05）。结论 体外循环下接受心脏手术的患者AKI发生率较高；术后2 h尿NGAL和NGAL/Ucr、术后2 h尿IL-18和尿IL-18/Ucr当达到一定界定值时，均可作为体外循环下心脏手术后AKI发生的早期诊断参考指标，其中术后2 h尿NGAL/Ucr为250 µg/mmol时更敏感。     

尿中性粒细胞明胶酶相关脂质运载蛋白在成人心脏手术后急性肾损伤早期诊断中的价值

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）在心脏手术后急性肾损伤（AKI）早期预测和诊断中的价值。 方法 前瞻性收集我院心脏手术患者手术前后不同时相的血、尿标本,选取其中14例AKI患者,分别测定尿NGAL和Scr水平;并选择临床资料相匹配的非AKI患者15例作为对照。观察两组患者围手术期尿NGAL和Scr的动态变化,运用接受者操作特性曲线（ROC）评价尿NGAL诊断AKI的精确性。AKI定义为Scr水平较基础值增加≥50%。 结果 Scr诊断AKI的中位时间为入ICU后24 h（10 h,48 h）。AKI患者术后入ICU即刻的尿NGAL水平显著高于术前基础水平并达峰值[20.51（13.42,50.02） μg/L比3.42（1.60,9.92） μg/L,P = 0.006];也显著高于非AKI患者 [2.91（0.72,8.61） μg/L,P = 0.002]。入ICU即刻尿NGAL 的ROC曲线下面积为0.824,95%的可信区间（CI）为0.667~0.980,P = 0.003。当以10.95 μg/L作为诊断截点时,此刻的尿NGAL在AKI诊断中的敏感性和特异性分别为85.7%和80.0%。入ICU即刻的尿NGAL与入ICU 24 h的Scr（r = 0.545,P = 0.002）及eGFR（r = －0.546,P = 0.002)呈正及负相关。 结论 心脏手术后AKI患者术后入ICU即刻的尿NGAL水平显著升高,对诊断AKI具有较高的准确性,其诊断AKI的时间早于Scr。尿NGAL可作为成人心脏术后AKI的早期诊断标志物。     

尿中性粒细胞明胶酶相关载脂蛋白和肝型脂肪酸结合蛋白对肝移植术后急性肾损伤的早期诊断价值

目的 探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）和肝型脂肪酸结合蛋白（L-FABP）在肝移植术后急性肾损伤（AKI）中的早期诊断价值。 方法 前瞻性收集2007至2008年间25例肝移植患者术前、门静脉开放后2、4、6、12、24、48、72和120 h的血液和尿液标本,检测Scr和尿NGAL及L-FABP水平。根据急性肾损伤网（AKIN）标准中的Scr标准将患者分为AKI组和非AKI组。观察两组各时间点尿NGAL、尿L-FABP和Scr水平的动态变化;运用受试者工作特征曲线（ROC）评价尿NGAL和L-FABP诊断AKI的精确性。 结果 25例患者中11例发生了术后AKI,两组患者术前、术中及术后情况差异无统计学意义。术后24 h AKI组与非AKI组的Scr差异有统计学意义[(90.48±50.32) 比（59.84±14.72） μmol/L,P < 0.05]。AKI组与非AKI组术后2～120 h尿L-FABP均显著升高,4 h时差异有统计学意义[2361.41（1036.89~4048.93） ng/mgCr比5246.97（2406.33~7688.21） ng/mgCr,P < 0.05]。AKI组术后2、4、6 h尿NGAL均显著高于非AKI组,差异有统计学意义 [69.02（29.79~237.29）比22.94（8.69~46.23） ng/mgCr,29.34（16.06~536.91）比 12.66（8.91~22.78） ng/mgCr和34.23（11.47~81.26）比11.84（6.57~20.10） ng/mgCr,均P < 0.05]。ROC曲线下面积（AUC）结果显示,与尿L-FABP相比（当4 h截断点为3451.75 ng/mgCr时,AUC为0.760）,尿NGAL对早期诊断AKI具有更高的敏感性和特异性（2、4、6 h的截断点分别为43.02、26.97和17.19 ng/mgCr时,AUC分别为0.766、0.773和0.773）。 结论 尿NGAL在肝移植术后早期AKI的诊断上表现出较高的敏感性和特异性,也许能作为肝移植术后AKI早期诊断的生物学标志物,但仍需要大样本的临床研究加以证实。     

尿肝型脂肪酸结合蛋白及其与尿中性粒细胞明胶酶相关脂质运载蛋白联合应用在成人心脏手术后急性肾损伤诊断中的作用

目的 探讨尿肝型脂肪酸结合蛋白( L-FABP)及其与尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)联合应用在预测成人心脏手术后急性肾损伤(AKI)的发生及严重程度中的价值,以期能为临床AKI的早期诊断提供方便可靠的方法.方法 前瞻性收集心脏手术患者术前、术后即刻及术后2h的血和尿标本,分别检测Scr、尿L-FABP和NGAL水平,比较AKI和非AKI患者术后各标志物的动态变化情况.运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估标志物单独及联合应用时诊断AKI的准确性.结果 总共109例患者中26例(23.9％)发生了AKI,其中AKIN Ⅰ、Ⅱ和Ⅲ期分别占46.2％ 、34.6％和19.2％.尿L-FABP 和NGAL水平在AKI组术后即刻及术后2h均显著高于非AKI组,其浓度变化明显早于Scr.两时间点各标志物单独预测AKI的发生及Ⅱ和Ⅲ期AKI的AUC均在0.81～0.87.用Logistic 回归方程联合术后同一时间点的尿NGAL和尿L-FABP,则术后即刻和术后2h预测术后AKI 及严重程度的精确性进一步提高( AUC=0.911～0.927).结论 尿L-FABP和尿NGAL在心脏术后AKI早期即显著升高,比Scr能更早地预测AKI的发生和严重程度,两者联合应用则可使诊断的精确性进一步提高.     

尿热休克蛋白-70在体外循环术后急性肾损伤早期诊断中的价值

目的评估尿热休克蛋白(HSP)-70在心脏体外循环心肺转流术(CPB)后急性肾损伤(AKI)早期诊断中的价值。方法选取2018年5月至2018年7月在河南省人民医院接受CPB治疗的患者为研究对象。收集入选者术前及术后0、2、4、6、8、12、24、48 h尿液标本和临床资料。按照肾脏病改善全球预后组织(KDIGO)AKI诊断标准分为AKI组和非AKI组。酶联免疫吸附法测定尿HSP-70、金属蛋白酶组织抑制因子2(TIMP-2)和胰岛素样生长因子结合蛋白7(IGFBP7)水平;免疫比浊法测定尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平。绘制受试者工作特征曲线(ROC),计算尿HSP-70、[TIMP-2]×[IGFBP7]、NGAL诊断CPB术后发生AKI的临界值、敏感度及特异度。结果共纳入45例患者,其中AKI组24例,非AKI组21例。AKI组术后各时间点尿HSP-70、[TIMP-2]×[IGFBP7]和NGAL水平显著高于非AKI组,组间比较差异有统计学意义(均P<0.05)。AKI组尿HSP-70在CPB术后2 h达到峰值,明显早于尿[TIMP-2]×[IGFBP7]、尿NGAL达峰值时间(分别为术后12 h和术后4 h)。术后2 h尿HSP-70≥2.1μg/L预测CPB术后AKI的曲线下面积(AUC)=1.00,灵敏度为100.0%,特异度100.0%;术后12 h尿[TIMP-2]×[IGFBP7]>19.1μg2/L2预测CPB术后AKI的AUC=0.94,灵敏度87.5%,特异度100.0%;术后4 h尿NGAL>27.4μg/L预测CPB术后AKI的AUC=0.95,灵敏度95.8%,特异度85.7%。术后2 h尿HSP-70≥2.1μg/L预测CPB术后AKI的阳性预测值为100.0%,阴性预测值100.0%。结论CPB术后AKI患者尿HSP-70水平升高早于尿[TIMP-2]×[IGFBP7]、NGAL,尿HSP-70水平监测有助于AKI的早期发现。     

尿液白介素18在冠状动脉介入术后造影剂肾损伤早期诊断中的意义

目的前瞻性研究尿液白介素18（IL-18）在早期预测和诊断冠状动脉造影术后急性肾损伤中的意义。方法收集150例接受冠状动脉造影及介入治疗患者的资料。造影剂肾病（CIN）以传统方法定义。用酶法测术前及术后24 h、48～72 h Scr值。留取患者术前、术后24 h尿液,用ELISA法检测发生CIN患者尿液IL-18、尿N-乙酰-β-D氨基葡萄糖酐酶（NAG）及尿视黄醇结合蛋白（RBP）的水平,并与未发生CIN的患者比较。结果150例患者中13例发生了CIN,发生率为8.7%。使用造影剂后24 h,患者尿液IL-18（ng/L）和NAG（U/L）水平显著升高[分别为15.06（12.21,21.31）比11.62（9.37,13.86）;13.88（7.09,33.23）比10.09 （5.96,16.62）,P均〈0.05];而尿RBP和Scr无显著变化。与非CIN组比较,CIN组术后尿IL-18 （ng/L）显著升高[18.97（13.64,48.57）比14.01（11.91,17.77）,P〈0.05]。相关分析显示,CIN组尿液IL-18与Scr呈正相关（r=0.664,P：0.013）,而尿NAG和RBP与Scr无相关。ROC分析证实,尿液IL-18在CIN早期诊断中的准确性较高,曲线下面积为0.749,P=0.012;当以15.8 ng/L作为诊断截点时,其在CIN诊断中的敏感性和特异性分别为69.2%和74.1%。队列研究结果显示,尿IL-18明显升高患者CIN发病的危险度最高,RR达3.125;而且在CIN患者中,尿IL-18明显上升的构成比最高（P〈0.05）。结论尿IL-18可较Scr更早提示造影剂肾脏损伤的发生,可能为较好的CIN早期诊断标志物。     

尿NGAL、NAG及KIM-1联合检测在高龄老年急性肾损伤早期诊断中的价值

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)、尿N-乙酰β-D氨基葡萄糖苷酶(uNAG)及尿肾损伤分子-1(uKIM-1)的联合检测老年急性肾损伤中的诊断价值。方法选择2016年6月至2018年6月在泰山疗养院住院的老年患者184例,根据急性肾损伤网络(AKIN)标准为诊断标准,诊断AKI组116例(1期55例、2期39例、3期24例),非AKI组68例,检测并比较各组尿NGAL、NAG、KIM-1水平,用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析3项生物学标志物对AIK的诊断价值。结果①AKI组尿NGAL、NAG、KIM-1明显高于对照组(P<0.05),3期尿NGAL、NAG、KIM-1明显高于2期和1期,2期明显高于1期(P<0.05);②尿NGAL、NAG、KIM-1单独诊断AKI的AUC分别为0.734、0.804、0.705;③3项标志物联合诊断AKI的灵敏度、特异度分别为84.9%、90.7%,高于各单项诊断。结论尿NGAL、NAG、KIM-1是诊断AKI的较好指标,联合诊断对高龄老年急性肾损伤的早期诊断有着更重要的价值。     

尿NGAL和L-FABP在儿童泌尿系统疾病致急性肾损伤诊断中的意义

目的:探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿肝型脂肪酸结合蛋白(L-FABP)对儿童泌尿系统疾病致急性肾损伤诊断中的意义。方法:选取本院小儿肾内科收治的泌尿系统疾病患儿108例,按照KDIGO的标准诊断AKI将患者儿分为AKI组(50例)与非AKI组(58例),参照AKI分期标准,将AKI组分为1期组、2期组和3期组。同期进行健康体检儿童46例作为对照组。用酶联免疫吸附法测定尿L-FABP、NGAL水平,并与Scr、APACHEⅡ积分进行相关分析。利用受试者工作特征ROC曲线分析二者对AKI的诊断效能。结果:AKI组患儿BUN、Scr、NGAL、L-FABP水平均高于非AKI组和对照组,且随着疾病分期增加而升高,比较差异具有统计学意义(P0.05);AKI组尿NGAL、L-FABP与Scr、APACHEⅡ积分呈正相关(P0.05);NGAL、L-FABP诊断AKI的AUC分别为0.846、0.893,二者联合诊断的AUC为0.951。结论:尿NGAL和L-FABP均可作为儿童泌尿系统疾病致AKI有价值的早期诊断生物标志物,观察患儿两项指标的整体的动态变化可反映AKI的病情及预后。     

尿NGAL对急性Stanford A型主动脉夹层手术后急性肾损伤的早期诊断价值

目的探讨尿液中性粒细胞明胶酶相关脂质转运蛋白(neutrophil gelatinase-associated lipocalin,NGAL)对急性Stanford A型主动脉夹层术后急性肾损伤(acute kidney injury,AKI)的早期诊断价值。方法以2018年1～12月在南京市第一医院诊断为急性Stanford A型主动脉夹层患者50例为研究对象,根据是否发生AKI分为两组:AKI组共27例患者,非AKI组共23例患者。收集术前以及术后2 h尿液标本,进行尿NGAL浓度监测,AKI的诊断采用全球改善肾脏疾病预后(KDIGO)分级诊断标准,采用受试者工作特征(ROC)曲线评估尿NGAL的诊断价值。结果急性Stanford A型主动脉夹层术后AKI的发生率达到54.0%(27/50),两组患者术前血肌酐浓度差异无统计学意义(P0.05),术后2 h血肌酐浓度的差异具有统计学意义(P0.05),而两组尿NGAL浓度在术前监测点差异即显示出统计学意义(P0.05)。术前尿NGAL的浓度诊断AKI的ROC曲线下面积为0.626,当cut-off值为43 ng/mL,敏感性40.7%,特异性95.7%,而术后2 h尿NGAL浓度的ROC曲线下面积为0.655,cut-off值为46.95 ng/mL时,敏感性是63.0%,特异性为78.3%。结论术前以及术后2 h尿NGAL水平可以预测术后AKI的发生,但其早期诊断价值有限。     

联合检测血清CysC、NGAL早期诊断冠脉造影剂所致急性肾损害

目的:探讨联合检测血清CysC、NGAL在冠脉造影剂所致急性肾损害早期诊断中的意义。方法:冠脉造影患者分为非AKI组,50例和AKI组,32例,以健康体检者50名为对照组。使用自动生化分析仪测定血清Scr浓度,采用免疫比浊法检测血清CysC,酶联免疫吸附法(ELISA)检测血清NGAL。结果:术前血清CysC、NGAL和Scr三组间差异无统计学意义(均P0.05)。术后12 h AKI组CysC和NGAL与术前比较差异显著,有统计学意义(均P0.05),Scr无统计学意义(P0.05)。术后24 h AKI组CysC、NGAL和Scr与术前比较差异均非常显著,有统计学意义(均P0.01)。术后24 h AKI组CysC和NGAL的异常检出率分别高达93.8%和87.5%,Scr为43.8%。并联CysC-NGAL试验的灵敏度最高,为96.9%,特异度为84.4%,Youden指数为0.813。结论:检测血清CysC、NGAL均能敏感地早期诊断冠脉造影剂所致急性肾损害,并联CysC-NGAL试验是最好的指标。     

Value of levels of biomarkers at the time of nephrologists consultation in predicting the prognosis of acute kidney injury patients

Objective To investigate the value of biomarker levels at the time of nephrologists consultation in predicting the prognosis of acute kidney injury (AKI) patients. Methods A total of 103 hospitalized patients with AKI were enrolled at the time of nephrologists consultation. Blood and urine samples were collected when patients were diagnosed as AKI. ELISA was used to detect the concentration of urinary biomarkers including neutrophil gelatinase?associated lipocalin (NGAL), IL?6 and IL?18. Colorimetric method was used to measure urinary N?acetyl?β?D?glucosaminidase (NAG). Turbidimetry and enzymic method were applied to examine the concentration of serum cystatin C (Cys C), baseline Scr (bScr), Scr at consultation (cScr) and the peak of Scr (pScr) respectively. Patients were followed?up to evaluate the prognosis at 28 days after consultation, including patient survival and kidney survival. The levels of biomarkers between different groups, including patient survival or death, kidney recovery or lose and renal replacement therapy (RRT) or not, were compared. Area under curve (AUC) of receiver operating characteristic (ROC) curve of these biomarkers were used to evaluate the sensitivity and specificity in predicting prognosis. AKI was defined as the Scr at the time of consultation increased more than 50% of baseline Scr within 48 hours. Results (1)Mean age of 103 hospitalized AKI patients was (54.28±19.05) years old and ratio of male to female was 1.86 to 1. (2)Patient mortality was 25.2% at 28 days after consultation. The bScr, cScr and pScr were similar between survival and death group, while the concentration of urinary NGAL in death group was significantly higher than that of survival group [147.00(31.59, 221.87) mg/L vs 22.43(6.48, 89.77) mg/L, P＝0.001]. The serum Cys C, urinary IL?6 and NAG were similar between survival and death group (P＞0.05). Logistic regression analysis showed urinary NGAL was an independent risk factor of patient survival (OR＝1.011, 95%CI 1.004?1.018, P＝0.001) with AUC of 0.723. (3)Kidney lose rate was 20.4% at 28 days after consultation. The bScr, cScr and pScr were similar between patients with kidney survival and lose. The levels of urinary NAG, IL?6, NGAL and IL?18 were significantly higher in patients with kidney lose than those of kidney survival. Logistic regression analysis showed urinary IL?6 was an independent risk factor of renal survival (OR＝1.056, 95%CI 1.009?1.105, P＝0.018) with AUC of 0.705. (4)The median time from consultation to RRT was 2.17 (0?3) days. The concentrations of cScr, pScr, serum Cys C, urinary IL?6 and NGAL were significantly higher in RRT patients than thosein non?RRT patients (P＜0.05). Logistic regression analysis showed urinary NGAL was an independent risk factor of RRT (OR＝1.012, 95%CI 1.005?1.019, P＜0.01) with AUC of 0.775. Conclusions Urinary NGAL can predict the prognosis of AKI patients, including patient prognosis and RRT. Urinary IL?6 may predict kidney prognosis in hospitalized patients with AKI. More study with large samples should be done for further estimation of the results.     

Klotho protein as a biomarker for the detection and prognosis of acute kidney injury among adult patients in the intensive care units

Objective To evaluate the clinical significance of serum Klotho protein levels in the early diagnosis and prognosis of acute kidney injury (AKI) among adult patients in the intensive care units (ICU). Methods The study was prospective and observational. Blood samples and clinical data of AKI patients admitted to the ICU of the First Affiliated Hospital of Xinjiang Medical University between July 1 and August 31, 2016 were collected. ELISA was used for the detection of Klotho and NGAL. Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to compare the predictive performance among Klotho, NGAL and serum creatinine, evaluating the sensitivity and specificity of Klotho on the diagnosis of AKI. The correlation between Klotho and prognosis of AKI was investigated by comparing serum Klotho levels and early AKI predictors. Results The patients were divided into AKI group of 52 cases and non-AKI group of 98 cases. The baseline serum Klotho level in AKI group was significantly lower than that in non-AKI group (P＜0.001). The AUC of Klotho predicting for AKI was 0.945(95% CI: 0.892-0.997) and the best cut off value was 1.76 μg/L(sensitivity 92%, specificity 94%). The predictive ability of Klotho was significantly higher than serum creatinine (Scr), and the sensitivity is higher than NGAL (sensitivity 87%, specificity 96%). Serum Klotho combined with Scr predicted better AKI (AUC=0.958, 95% CI: 0.915-1.000, sensitivity 96%, sensitivity 92%). The level of Klotho in patients with AKI was significantly different between the renal function recovery group and non-recovery group (P=0.047), while there was no significant difference between the two groups in the level of NGAL and Scr (P＞0.05). There was no significant correlation between the Klotho level at diagnosis of AKI and peak Scr, peak eGFR, Scr at discharge and eGFR at discharge (r=0.026, P=0.853; r=-0.127, P=0.368; r=0.243, P=0.082; r=-0.187, P=0.184). Conclusion Serum Klotho may be a potential biomarker for early diagnosis of AKI, but the association between serum klotho and the prognosis of AKI requires further study.     

Prediction of acute kidney injury complicated by sepsis with sTREM - 1 and NGAL as early marker

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM - 1) and urinary neutrophil gelatinase - associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis. Methods A total of 141 eligible patients were enrolled in this prospective study. Blood and urine samples were collected at different time points as soon as sepsis was diagnosed. The concentrations of serum creatinine (Scr), urine sTREM-1 and NGAL were measured. According to AKI criteria, patients were divided into the AKI group and non - AKI group. Dynamic changes of levels of Scr, urine sTREM-1 and NGAL were observed in two groups. The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL. Results Among 141 septic patients, 44 (31.2%) cases had concomitant AKI. Twenty four hours after sepsis diagnosed, the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6±15.3) μmol/L, P＜0.05], which met the diagnostic criteria of AKI. In the AKI group, urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9±14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L, both P＜0.05].And at the following time points, urinary concentrations of sTREM - 1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P＜0.05). At 8 h time point, the area under the curve of urine sTREM-1 was 0.877 (95%CI 0.756-0.914), the sensitivity was 89.1% and specificity was 82.0% with a cutoff value of 70 ng/L. At 8 h time point, the area under the curve of urine NGAL was 0.862 (95% CI 0.703-0.958),the sensitivity was 87.4% and specificity was 85.5% with a cutoff value of 90 μg/L. Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr. Therefore, urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.     

Neutrophil gelatinase associated lipocalin as an indicator of acute kidney injury and inflammation in burned children

Introduction

Neutrophil gelatinase associated lipocalin (NGAL) is a novel predictor of acute kidney injury (AKI), which increases with inflammation. We aimed to assess whether serum NGAL (SNGAL) and urine NGAL (UNGAL) can predict AKI in burned children.

Methods

Patients were referred within the 12 h of burn to our center. Serum samples for SNGAL, C-reactive protein (CRP), procalcitonin (PCT) and urine for UNGAL, microalbumine (Umalb), creatinine (Ucr) were obtained at both admission and the 5th day after burn. Blood urea nitrogen (BUN) and serum creatinine (Scr) were examined daily.

Results

Twenty-two subjects were enrolled and six (27.2%) of them developed AKI within the 48 h of injury. Burn size and abbreviated burn severity index (ABSI) were significantly increased in patients with AKI. CRP, PCT, SNGAL and UNGAL levels at admission and day 5 were significantly higher in patients with AKI than in those without AKI and controls. Scr was not significant between AKI and non-AKI groups at hospital days 1 and 5. A SNGAL level of 315 ng/ml and a UNGAL level of 100 ng/ml were determined as predictive cut-off values of AKI at admission (sensitivity and specificity: 71.4%, 83.3% and 93.3%, 93.7%, respectively). SNGAL and UNGAL were positively correlated with CRP, PCT, ABSI and Umalb/Ucr.

Conclusion

SNGAL and UNGAL are good early predictors of AKI in children with severe burn. NGAL might reflect the severity of burn insult and also could be used as an indicator of inflammation in burn children.     

重症感染合并急性肾损伤中NGAL的变化

目的探讨尿中性粒细胞明胶酶相关载脂蛋白在重症感染合并急性。肾损伤中的诊断价值。方法选择2010年1月--2011年6月在新疆自治区人民医院ICU住院的重症感染患者79例,按急性肾损伤的诊断标准分为急性肾损伤组和非急性肾损伤组。分别测定尿中性粒细胞明胶酶相关载脂蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、微量白蛋白和血肌酐的浓度。通过受试者工作特征曲线及曲线下面积评价各项指标的敏感性。结果急性肾损伤组中各项指标的测定浓度明显高于非急性肾损伤组,其中尿中性粒细胞明胶酶相关载脂蛋白的敏感性和特异性分别为0．95和0．90,曲线下面积=0．986（0．9681．004）;血肌酐的敏感性和特异性分别为0．75和0．69,曲线下面积=0．776（0．705～0．852）,差异具有统计学意义（P〈0．001）。结论’尿中性粒细胞明胶酶相关载脂蛋白的敏感性高于血肌酐,可以作为重症感染合并急性肾损伤的早期诊断标记物。     

尿生物标志物在儿童急性肾损伤早期诊断中的作用研究

目的：评价尿NGAL,KIM-1和β2-MG在儿童不同基础疾病导致的AKI早期诊断中的价值。方法：我们做的是前瞻性临床研究,检测在我院儿科门急诊不同疾病患儿尿中性粒细胞明胶酶相关的脂质运载蛋白（NGAL）,肾脏损伤因子-1（KIM-1）和-β2微球蛋白（β2-MG）的水平,以AKIpRIFLE为分期标准将入选患儿分组,比较尿NGAL,KIM-1和β2-MG在儿童急性肾损伤诊断中的敏感性,特异性,阳性似然比,阴性似然比,分析比较这3个指标在急性肾损伤早期诊断中的作用。结果：入选262例患儿中,23例患儿可诊断为AKI,15例患儿为AKI-R期,8例患儿为AKI-I期,入选患儿中没有AKI-F期,23例患儿中只有5例临床有AKI的诊断。尿NGAL,KIM-1和β2-MG的水平在血肌酐没有明显升高之前已经升高,随着肾损伤的加重升高的更明显,不同组间差异有统计学意义。尿NGAL和β2-MG在预测儿童AKI的早期诊断方面好于尿KIM-1（AUC〉0.8）。结论：尿NGAL,KIM-1和β2-MG均可以在Scr没有升高之前预测儿童AKI的发生,是儿童AKI的早期生物标志物。尿NGAL在早期预测不同基础疾病可能发生AKI方面好于其他两项指标。