维持性血液透析患者血清中性粒细胞明胶酶相关载脂蛋白水平与透析充分性、铁代谢及微炎性反应状态的相关性

目的 研究维持性血液透析(MHD)患者血清中性粒细胞明胶酶相关载脂蛋白(NGAL)水平与透析充分性、微炎性反应状态及铁代谢的关系；探讨NGAL对判断透析充分性的价值.方法 从2010年10月开始,纳入我院MHD患者150例为对象,同时以50例健康人为对照.收集MHD患者的人口学资料、临床表现及检测参试者血清NGAL、C反应蛋白( CRP)、转铁蛋白饱和度(TSAT)、铁蛋白等水平.根据单室尿素清除指数(spKt/V)值将MHD 患者分为透析充分组和不充分组,比较组间血清NGAL差异.用Pearson相关法、多元线性回归模型和受试者工作特征(ROC)曲线分析NAGL与Kt/V、炎性因子和铁代谢指标等相关性.患者随访3个月,对比两组随访前后NAGL、Kt/V及炎性因子变化,进一步评估血清NGAL与透析充分性、炎性指标的关系.结果 MHD患者血清NGAL为(445.45±50.34) μg/L,显著高于健康对照的(50.02±6.45) μg/L(P＜0.01).150例MHD患者中,95例为充分组,55例为不充分组.充分组与不充分组NGAL分别为(589.14±56.34) μg/L和(360.13±46.23)μg/L,差异有统计学意义(P＜0.05).MHD患者血清NGAL与spKt/V、CRP、TSAT呈正相关(r=0.652、0.825、0.785,均P＜0.05).多元线性回归模型结果显示,NGAL与CRP、spKt/V、TSAT有相关关系.ROC曲线下面积(AUC)表明,NGAL水平能较好地反映透析充分性.随诊后结果显示,所有充分组患者均维持透析充分状态；经干预后,不充分组中38例达透析充分,另17例仍未达到透析充分.在这38例中,未达充分和达充分时的NGAL分别为(368.14±56.21) μg/L和( 360.56±46.23) μg/L,差异无统计学意义.CRP水平达充分后有所下降,但差异无统计学意义.结论 MHD透析充分患者血清NGAL显著高于不充分患者.MHD患者血清NGAL与spKt/V、CRP及TSAT均呈正相关.血清NGAL能较好地反映透析充分性.

Correlation of neutrophil gelatinase-associated lipocalin with dialysis adequacy, microinflammation and iron metabolism in maintenance hemodialysis patients

Objective To examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with dialysis adequacy, microinflammatory state and iron metabolism, and to assess the value of NGAL in identifying the dialysis adequacy in maintenance hemodialysis (MHD) patients. Methods A total of 150 MHD patients and 50 healthy control people were enrolled in the study. Clinical data were collected and serum NGAL, CRP, transferrin saturation, serum ferritin were measured. MHD patients were divided into adequacy group and non-adequacy group according to spKt/V value. Serum NGAL between two groups was compared and correlation of NGAL with spKt/V, inflammatory factors, and other clinical indexes was examined by Pearson, multivariate regression Logistic model and area under curve (AUC) of ROC. MHD patients were followed up for 3 months. Similar correlation analysis was carried out before and after follow up between two groups. Results Serum NGAL of MHD patients was higher compared to healthy people (445.45±50.34) μg/L vs (50.02±6.45) μg/L]. Among 150 MHD patients, 95 were classified into adequacy group, while 55 into non-adequacy group according to spKt/V value. Serum NGAL was significantly higher in adequacy group as compared to non-adequacy group (589.14±56.34) μg/L vs (360.13±46.23) μg/L, P<0.05]. Serum NGAL was positively correlated to spKt/V, CRP, TSAT r=0.652, 0.825, 0.785, all P<0.05], but not to serum ferritin. Serum NGAL was also correlated to spKt/V, CRP, TSAT by multivariate regression Logistic model. AUC showed that NGAL level could reflex the condition of dialysis adequacy. During the follow up, all adequacy patients remained the same adequacy status. Thirty-eight out of 55 non-adequacy patients were qualified for complete adequacy after intervention. The serum NGAL before and after intervention was (368.14±56.21) μg/L and (360.56±46.23) μg/L respectively without significant difference. Conclusions Serum NGAL is obviously higher in MHD patients with dialysis adequacy compared to those without dialysis adequacy. Serum NGAL is positively correlated to spKt/V, CRP, TSAT. NGAL can reflex the condition of dialysis adequate in MHD patients.