不同生物学标志物诊断感染相关性急性肾损伤临床对照研究

目的评价血清中性粒细胞胶原酶相关脂质运载蛋白(sNGAL)、尿中性粒细胞胶原酶相关脂质运载蛋白(uNGAL)、尿肾损伤因子-1(uKIM-1)、尿白细胞介素-18(uIL-18)对感染相关性急性肾损伤的诊断作用。方法纳入2010年6月至2011年2月入住首都医科大学附属复兴医院重症医学科时间≥24 h的成年全身性感染患者。测定ICU全身性感染患者入组即刻的sNGAL、uNGAL、uIL-18、uKIM-1,根据入组后48 h的肌酐和尿量,以急性肾损伤网络(AKIN)分期1期为标准,分为急性肾损伤组和非急性肾损伤组。比较上述生物标志物的组间差异,并绘制受试者工作特征曲线,评价生物标志物在感染相关性肾损伤的诊断作用。结果共入选86例全身性感染患者,其中急性肾损伤45例(52.3%)。急性肾损伤组sNGAL320.3μg/L(195.8～536.0μg/L)对192.2μg/L(138.6～317.1μg/L),P=0.002]、uNGAL374.8μg/L(81.0～875.2μg/L)对55.6μg/L(32.8～155.0μg/L),P=0.0001]显著高于非急性肾损伤组,而两组间uIL-18、uKIM-1浓度差异无统计学意义。sNGAL和uNGAL诊断急性肾损伤曲线下面积分别为0.69(0.58～0.79)和0.75(0.64～0.84)。结论 uNGAL、sNGAL在感染相关性急性肾损伤升高,并显著高于非急性肾损伤患者,uNGAL水平随肾损伤程度加重而升高。NGAL可能成为感染相关性急性肾损伤的生物学标志物。

Assessment and appraisal of biomarkers in patients with septic acute renal injury

Objective To determine the diagnostic significance of serum neutrophil gelatinase-associated lipocalin(sNGAL),urinary neutrophil gelatinase lipocalin(uNGAL),urinary interleukin-18(uIL-18) and urinary kidney injury molecule-1(uKIM-1) in patients with septic acute renal injury.Methods We enrolled adult patients with sepsis who were to have Intensive Care Unit stay within the next 24 hours in Fuxing Hospital of Capital Medical University between June 2010 and February 2011.Measurements of sNGAL,uNGAL,uIL-18 and uKIM-1 were performed during enrollment.Subjects were then allocated into acute renal injury group and non-acute renal injury group,based on 48-hour urine output and creatinine level,with Acute Kidney Injury Net(AKIN) work stage 1 as the diagnostic criteria.By comparing between-group distinction,the diagnosis value of aforementioned biomarkers was assessed via depicting receiver operation characteristic curves.Results Of 86 patients with sepsis enrolled in this study,45(52.3%) developed acute renal injury.Acute renal injury group yielded considerably higher(P=0.002) sNGAL level(320.3 μg/L,interquartile range:195.8~536.0 μg/L vs 192.2 μg/L,interquartile range:138.6~317.1 μg/L).Higher uNGAL(P=0.0001) was also found in acute renal injury group(374.8 μg/L,interquartile range:81.0~875.2 μg/L)as compared with non-acute renal injury group(55.6 μg/L,interquartile range:32.8~155.0 μg/L).There was no significant difference in uKIM-1 and uIL-18 between both groups.The area under curve of sNGAL and uNGAL was(0.69,95%CI 0.65~0.89)and(0.75,95%CI 0.64~0.84)for acute renal injury group and non-acute renal injury group,respectively.Conclusion Patients with septic acute renal injury are found to have significant increase in sNGAL and uNGAL as compared with those who had non-acute renal injury.Higher uNGAL level is associated with more severe renal injury.NGAL might be helpful as a biomarker of septic acute renal injury.