中性粒细胞明胶酶相关载脂蛋白对重症监护病房成年患者急性肾损伤的预测价值

目的 评价血中性粒细胞明胶酶相关载脂蛋白(NGAL)对重症监护病房(ICU)成年人急性肾损伤(AKI)预测价值及对AKI严重程度的评估能力.方法 收集2009年8月至2010年8月辽宁省人民医院ICU患者316例,参照急性肾损伤网络(AKIN)诊断标准,将患者分为无AKI组和AKI组,依据AKI的分期再将患者分为AKI危险组,AKI损伤组和AKI衰竭组.对各组间变量进行分析比较,应用受试者工作特征(ROC)曲线,评价血NGAL对AKI的早期预测价值.结果 患者入住ICU后血NGAL水平与AKI密切相关,AKI组患者血NGAL(293.284±91.831)μg/L较无AKI患者血NGAL(183.517±141.141) μg/L显著增高,差异有统计学意义.血NGAL水平随着AKI严重程度的变化而变化.以血NGAL水平绘制ROC曲线,其中预测AKI的曲线下面积(AUC)是0.797(95％ CI =0.750～0.844,P＜0.01)；预测肾损伤的AUC是0.892(95％ CI =0.853～0.931,P＜0.01)；预测肾衰竭的AUC是0.960(95％ CI =0.927～0.993,P＜0.01).结论 对于ICU成年患者血NGAL可以作为AKI早期预警指标并且可以作为AKI严重程度的评估标准.

Neutrophil gelatinase-associated lipocalin at intensive care unit admission predicts for acute kidney injury in adult patients

Objective To assess the value of plasma neutrophil gelatinase-associated lipocalin（NGAL） to predict acute kidney injury （AKI） and the ability of plasma NGAL to predict AKI severity in adult critically ill patients at intensive care unit （ICU） admission. Methods We collected 316 cases over a year period during Aug. 2009-Aug. 2010 in ICU, then divided the patients into four groups according to AKI network（AKIN） （non-AKI, AKI risk group, AKI injury group and AKI failure group）. Then, we compared the differences of variables among different groups. Receiver operating characteristic cure （ROC） method was applied to evaluate plasma NGAL predictive value of AKI. Results Plasma NGAL values at ICU admission were significantly related to AKI. Plasma NGAL was obviously higher in AKI group than non-AKI group, （293. 284 ± 91. 831）μ/L and （ 183. 517 ± 141. 141 ） μ/L, respectively. Plasma NGAL concentration changed with the severity of AKI. The areas under the ROC for plasma NGAL were AKI 0. 797 （95% CI 0. 750-0. 844, P d0. 05）, kidney injury 0. 892 （95 % CI = O. 853-0. 931, P 〈 0.05）, and kidney failure 0. 960 （95% CI = 0. 927-0. 993, P〈0.05） ,respectively. Conclusion Plasma NGAL should be served as an early warning marker for patients with AKI at ICU admission.Plasma NGAL can be used as a serious degree evaluation criterion of AKI.