NGAL对成人心脏术后急性肾损伤的早期诊断价值

目的:探讨血和尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平对成人心脏术后急性肾损伤(AKI)的早期诊断价值.方法:收集112例心脏手术患者手术前后不同时相的血、尿标本,分别测定血肌酐(Scr)、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Scr、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:112例患者中21例术后24 h Scr水平上升至基础值的1.72倍,AKI发生率为18.8%.AKI组术后2 h血NGAL开始显著增高并达到峰值,与基线值比较差异有统计学意义[分别为(82.2±22.3) ng·ml-1和(16.9±3.1) ng·ml-1,P<0.05];尿NGAL较基线值明显上升[分别为(132.4±41.1) ng·ml-1和(30.8±23.1) ng·ml-1,P<0.05],并在术后4 h达到峰值.AKI组术后2 h,血NGAL诊断AKI的ROC曲线下面积为0.866,95%的可信区间为0.756~0.976,以19 ng·ml-1作为AKI的诊断界限时,敏感性和特异性分别为85.7%和88.4%;尿NGAL的ROC曲线下面积为0.914,95%的可信区间为0.86~0.966,以56 ng·ml-1作为AKI的诊断界限时,敏感性和特异性分别为95.2%和88.4%.结论:心脏手术后2 h的血、尿NGAL水平对AKI具有预测价值,其出现变化时间远早于Scr;血、尿NGAL可作为心脏术后并发AKI患者的早期诊断的标记物.

Value of neutrophil gelatinase-associated lipocalin on early diagnosis of acute kidney injury after adult cardiac surgery

Objective: To investigate the early diagnosis value of neutrophil gelatinase-associated lipocalin(NGAL) on acute kidney injury(AKI) in patients undergoing heart surgery.Methods: Serial blood and urine samples were collected from 112 hospitalization patients undergone cardiac surgery before and after surgery.The concentrations of serum creatinine(Scr),serum NGAL and urine NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,serum NGAL and urine NGAL of the two groups were observed.The receiver operating characteristic curve was used to evaluate the early diagnostic value of serum NGAL and urine NGAL.Results: After heart surgery 21 patients(18.8%) developed AKI.The level of Scr elevated to the base value 1.72 times 24 h after surgery.In the AKI group,serum concentration of NGAL at 2 h time point was significantly raised compared with baseline[(82.2±22.3) ng·ml-1 vs(16.9±3.1) ng·ml-1,P<0.05] and reached the peak level at the same time.In the AKI group,the urinary concentration of NGAL at 2 h time point was significantly raised compared with baseline[(132.4±41.1) ng·ml-1 vs(30.8±23.1) ng·ml-1,P<0.05] and reached the peak level at 4 h time point.At 2 h time point after heart surgery,the area under the curve of serum NGAL was 0.866(95%CI 0.756-0.976),the sensitivity was 85.7% and specificity was 88.4% with a cutoff value of 19 ng·ml-1.For concentration in urine of NGAL at 2 h,the area under the curve was 0.914(95%CI 0.862-0.966),the sensitivity was 95.2% and specificity was 88.4% with a cutoff value of 56 ng·ml-1.Conclusions: Serum and urine concentrations of NGAL at 2 h after cardiac surgery are predictive of AKI,which are much earlier than Scr.NGAL can be used as early biomarkers for AKI after cardiac surgery.