| uNGAL联合尿NAG对危重症患者急性肾损伤病情及预后的评估价值#br# |
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| 引用本文： | 张艳,靳衡,曹超,寿松涛△. uNGAL联合尿NAG对危重症患者急性肾损伤病情及预后的评估价值#br#[J]. 天津医药, 2021, 49(5): 495-498. DOI: 10.11958/20202746 |
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| 作者姓名： | 张艳 靳衡 曹超 寿松涛△ |
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| 作者单位： | 天津医科大学总医院急诊医学科（邮编300052） |
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| 基金项目： | 国家自然科学基金面上资助项目（82072222）；国家自然科学基金青年资助项目（81902007）；中央高校基本科研业务费专项资金（3332019127） |
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| 摘 要： | 摘要：目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）联合尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）对危重症患者急性肾损伤（AKI）病情及预后的评估价值。方法 选取危重症合并AKI的患者101例（AKI组）和同期收治的非AKI患者27例（对照组）。比较2组患者入院后24 h内血肌酐、血钾、血白蛋白和阴离子间隙（AG）、uNGAL、尿NAG、尿蛋白、尿微量白蛋白的差异。AKI组患者根据肾功能损伤严重程度分为Stage 1组（40例），Stage 2组（36例）和Stage 3组（25例），另根据患者出院时存活情况，分为存活组（63例）和死亡组（38例）。比较不同严重程度及不同生存状态间上述指标的差异。应用Logistic回归分析危重症患者AKI预后的独立影响因素，受试者工作特征（ROC）曲线评价uNGAL联合尿NAG对危重症患者AKI预后的评估价值。结果 （1）与非AKI组相比，AKI组uNGAL、尿NAG、尿蛋白、尿微量白蛋白、血肌酐水平升高，血清白蛋白水平降低（P＜0.01）。亚组分析结果显示，随着病情的加重，AKI组uNGAL、尿NAG和血肌酐水平均出现明显升高（P＜0.05）；同时死亡组uNGAL、尿NAG、尿微量白蛋白、尿蛋白及血肌酐高于存活组，血清白蛋白低于存活组（P＜0.05）。Logistic回归分析显示，uNGAL和尿NAG升高是影响患者预后的独立危险因素，ROC曲线显示uNGAL联合尿NAG预测预后的曲线下面积（0.886）优于uNGAL（0.850）、尿NAG（0.784）。结论 uNGAL联合尿NAG检测有助于对危重症患者急性肾损伤的危险分层和预后评估。
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| 关 键 词： | 危重病 急性肾损伤 死亡 尿中性粒细胞明胶酶相关脂质运载蛋白 尿N-乙酰-β-D-氨基葡萄糖苷酶 |
| 收稿时间： | 2020-10-09 |
| 修稿时间： | 2021-01-25 |
The value of uNGAL combined with urinary NAG in the evaluating the severity and prognosis of critically ill patients with acute kidney injury |
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| ZHANG Yan,JIN Heng,CAO Chao,SHOU Song-tao△. The value of uNGAL combined with urinary NAG in the evaluating the severity and prognosis of critically ill patients with acute kidney injury[J]. Tianjin Medical Journal, 2021, 49(5): 495-498. DOI: 10.11958/20202746 |
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| Authors: | ZHANG Yan JIN Heng CAO Chao SHOU Song-tao△ |
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| Affiliation: | Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China |
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| Abstract: | Abstract: Objective To assess the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL) and urinary N-acetyl-beta-D glucosaminidase (NAG) in risk stratification and prognosis for critically ill patients with acute kidney injury (AKI). Methods A total of 101 critically ill patients with AKI were included in the AKI group, and another 27 critically ill patients without AKI during the same period were included as the control group. Clinical and experimental indicators, including serum creatinine, serum potassium, serum albumin, anion gap, uNGAL, urinary NAG, urinary protein and urinary microalbuminuria were compared between the two groups. Based on the severity of kidney injury, patients were divided into Stage 1 group (n=40), Stage 2 group (n=36) and Stage 3 group (n=25). Besides, regarding the survival status of discharge，patients were divided into survival group (n=63) and death group (n=38). The indicators we collected were compared with different severity and living state. Logistic analysis was used to find out the independent risk factors affecting the prognosis of critically ill patients with AKI. The receiver operating characteristics (ROC) curve was used to evaluate the predictive ability of uNGAL, urinary NAG and uNGAL combined with urinary NAG in critically ill patients with AKI. Results Compared with control group, the levels of uNGAL, urinary NAG, urinary protein, urinary microalbuminuria and serum creatinine increased and the level of serum albumin decreased in AKI group (P＜0.01). The subgroup analysis indicated that the levels of uNGAL and urinary NAG increased with the severity of kidney injury in critically ill patients (P＜0.05). At the same time, compared with the survival group，the levels of uNGAL，urinary NAG，urinary microalbumin urinary protein and serum creatinine were significantly higher and the level of serum albumin was lower in death group (P＜0.05). Logistic regressionanalysis showed that the increased levels of uNGAL and urinary NAG were the independent risk factors for prognosis in patients. The ROC curve indicated the area under curve (AUC) of uNGAL combined with urinary NAG was 0.886, which was superior to the uNGAL (0.850) and urinary NAG (0.784) separately. Conclusion uNGAL combined with urinary NAG is helpful for evaluating the severity and prognosis of critically ill patients with AKI. |
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| Keywords: | critical illness acute kidney injury death urinary neutrophil gelatinase-associated lipocalin urinary N-acetyl-beta-D glucosaminidase |
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