NGAL和Cys C对重型颅脑损伤并发急性肾损伤的早期诊断价值

目的探讨血清中性粒细胞明胶酶相关载脂蛋白（neutrophil gelatinase-associated li-pocalin,NGAL）和半胱氨酸蛋白酶抑制剂C（Cys C）对重型颅脑损伤后并发急性肾损伤（acute kidney injury,AKI）的预测价值。方法选取85例重型颅脑损伤患者（GCS≤8）,收集患者入院后即刻（〈15 min）、2、4、6、8、10、12、18、24、36、48及72 h时的血标本,根据是否发生AKI分为AKI组（39例）及非AKI组（46例）。同时以25名健康体检者作为正常对照组。采用双抗体夹心酶联免疫吸附法（ELISA）检测血清NGAL浓度；用肌氨酸氧化酶法测定SCr水平；用免疫投射比浊法测定血清Cys C水平。以各项目入院即刻检查值作为基线值。结果85例重型颅脑损伤患者中有39例发生 AKI,发生率为45.9%。AKI组SCr水平自入院36 h开始明显升高,各时间点的检测值均高于基线值和正常对照组（P〈0.01）。AKI组入院36、48及72h SCr水平明显高于无AKI组（P〈0.01）。非 AKI组各时间点的SCr水平与正常对照组比较,差异无统计学意义（P〉0.05）。AKI组血清 NGAL 水平在入院2 h时已明显高于基线值（P〈0.01）,以后各时间点呈逐渐升高趋势,均高于基线值和正常对照组（P〈0.01）。非AKI组血清NGAL水平自入院10 h时开始逐渐升高,与基线值和正常对照组比较,差异有统计学意义（P〈0.01）。AKI组各时间点NGAL水平均明显高于非AKI组（P〈0.01）。AKI组血清Cys C水平在入院8 h时已明显高于基线值（P〈0.01）,以后各时间点呈逐渐升高趋势,均高于基线值和正常对照组（P〈0.01）。非AKI组血清Cys C水平自入院12h时开始明显升高,与基线值和正常对照组比较,差异有统计学意义（P〈0.01）。结论重型颅脑损伤后2 h 血清 NGAL即可明显升高,血清Cys C 于8h开始升高,其诊断AKI的时间早于SCr。血清NGAL和Cys C可作为重型颅脑损伤后诊断 AKI的早期标志物。

Predictive value of neutrophil gelatinase-associated lipocalin and cystatin C for of severe traumatic brain injury with acute kidney injury

Objective To assess the predictive value of neutrophil gelatinase-associated lipocalin （NGAL） and cystatin（Cys） C for acute kidney injury（AKI）.Methods Thebloodspecimensfrom85 patients with severe traumatic brain injury were collected immediately after admission,and at 2,4,6, 8,10,12,18,24,36,48 and 72 h.According to the occurrence of AKI,they were classified into AKI group （39 cases）and non-AKI group （46 cases）.A total of 25 healthy subjects were enrolled as control group. The serum NGAL level was determined by enzyme-linked immunosorbent assay （ELISA）.The serum creatinine levels were determined by creatinine enzymatic assay.The serum Cys C levels were determined by immune turbidimetry.The admission immediate detection values served as thebaselinevalues.Results In 85 patients with severe traumatic brain injury,39 patients had AKI（45.9%）.In AKI group at each time point since the beginning of 36 h,the SCr levels were increased significantly as comapred with the baseline values and those in non-AKI group （P〈0.01 ）.In AKI group,SCr levels at 36,48 and 72 h were significantly higher than those in non-AKI group （P〈0.01）.In non-AKI group at each time point,SCr levels had no statistically significant difference from those in the control group （P〉0.05）.In AKI group,NGAL levels at 2 h were significantly higher than the baseline values,and had a gradual rising trend after that time point.As compared with those in the control group and the baseline values,the differences were statistically significant （P〈0.01）. In non-AKI group,NGAL levels at 1 0 h was gradually increased,and as compared with those in the control goup and the baseline values,the difference was statistically significant （P〈0.01 ）.In AKI group,NGAL levels at each time point were obviously higher than those in non-AKI group （P〈0.01）.SErum Cys C levels in AKI group at 8 h were significantly higher than the baseline values （P〈0.01）.The reafter,the Cys C levels were increased gradually and highe