冠心病慢性心力衰竭患者尿中性粒细胞明胶酶相关脂质运载蛋白的水平及其临床意义

 目的 探讨冠心病慢性心力衰竭患者尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平变化及临床意义。方法 收集2014-09至2015-04在武警后勤学院附属医院心脏中心就诊的冠心病慢性心力衰竭患者90例,依据NYHA(纽约心脏协会)心功能分级分为Ⅰ级组、Ⅱ级组、Ⅲ～Ⅳ级组,每组30例,健康对照组(30例)。检测各组尿NGAL及血清肌酐(serum creatinine,Scr)、血清N末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平,测量患者左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、 左室射血分数(left ventricular ejection fraction,LVEF),并分析各组不同指标的水平变化及临床意义。结果 健康对照组,NYHAⅠ级、Ⅱ级、Ⅲ～Ⅳ级组尿NGAL水平随着心力衰竭程度加重(NYHA分级、LVEDD增加、LVEF值下降、NT-proBNP升高)而升高,以NYHAⅢ-Ⅳ级组升高最为明显(P＜0.01);与健康对照组比较NYHAⅡ级组尿NGAL水平即有所升高,具有统计学意义(P＜0.05),而Scr水平较健康对照组变化,差异无统计学意义。结论 冠心病慢性心力衰竭患者尿NGAL水平升高出现于Scr之前,提示尿NGAL是诊断冠心病心力衰竭患者早期肾损害敏感而准确的指标之一。

Changes and clinical significance of urinary NGAL in chronic heart failure patients with coronary heart disease

Objective To study the changes of urinary neutrophil gelatinase-associated lipid (NGAL) level and its clinical significance in chronic heart failure patients with coronary heart disease.Methods From September 2014 to April 2015,90 chronic heart failure patients with coronary heart disease were divided into 3 groups according to the NYHA cardioac functional classification,30 cases in classⅠgroup, 30 cases in class Ⅱ group, 30 cases in class Ⅲ-Ⅳgroup .And then 30 healthy subjects were recruited in control group. The level of urine NGAL, serum creatinine, N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected in 4 groups. The left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) were measured. And then the changes and clinical significance of each index were analyzed.Results With the heart failure severity ,the level of uNGAL in healthy control group, class Ⅰ,Ⅱ and Ⅲ-Ⅳ group patients increased, and class Ⅲ-Ⅳ increased most significantly.Compared with the control group , the level of uNGAL in class Ⅱ group, which was significantly higher than in control group (P<0.05), but no significant difference in Scr,compared with the control group. Conclusions The changes of uNGAL in patients of CHF with coronary heart disease increased earlier than Scr, which suggests that uNGAL is a sensitive and reliable marker for early renal damage in patients of CHF with coronary heart disease.