血清肌酐、胱抑素C、NGAL检测对妊娠相关急性肾损伤诊断及预后评估的价值

目的:探讨血清肌酐(SCr)、胱抑素C(Cys-C)、中性粒细胞明胶酶相关载脂蛋白(NGAL)检测对妊娠相关急性肾损伤(RP-AKI)诊断及预后评估的价值。方法:将RP-AKI患者93例按照产后随访结果分为预后不佳组27例和预后良好组66例,另选择100例正常分娩的产妇作为对照组,采用肌氨酸氧化酶法检测SCr水平,乳胶增强免疫透射比浊法检测血清Cys-C水平,双抗夹心酶联免疫吸附实验检测血清NGAL水平,logistic多元回归分析RP-AKI或预后不佳的危险因素,利用受试者工作曲线(ROC)预测SCr、Cys-C、NGAL对RP-AKI或预后不佳的诊断价值。结果:RP-AKI组SCr、Cys-C、NGAL水平均高于对照组(P<0.05)。产后3个月、6个月、12个月,预后不佳组SCr、Cys-C、NGAL水平均高于预后良好组(P<0.05)。相关性分析显示,RP-AKI组血清SCr水平与Cys-C和NGAL均呈正相关(均P<0.05),Cys-C与NGAL呈正相关(P<0.05)。logistic回归分析显示,SCr、Cys-C、NGAL是RP-AKI预后不佳的独立危险因素(均P<0.05)。NGAL诊断RP-AKI的最佳临界值为17.98μg/L,敏感度为82.7%,特异度为87.9%,ROC曲线下面积(AUC)为0.946(P<0.05),NGAL诊断RP-AKI的AUC高于SCr(AUC 0.851)和Cys-C(AUC 0.817)(均P<0.05)。SCr预测RP-AKI预后不佳的最佳临界值为127.63μmoI/L,敏感度为79.4%,特异度为83.1%,ROC曲线下面积为0.893(P<0.05),SCr预测RP-AKI预后不佳的AUC高于Cys-C(AUC0.754)、NGAL(AUC0.803)(P<0.05)。结论:NGAL对RP-AKI的诊断价值高于SCr和Cys-C,SCr对RP-AKI预后的预测价值高于Cys-C和NGAL。

The value of testing SCr,Cys C,and NGAL on diagnosis and prognosis prediction of pregnancy related acute kidney injury of pregnant women

Objective:To explore the value of testing serum creatinine (SCr),Cystatin C (Cys C),and neutrophil gela tinase associated lipocalin (NGAL) on diagnosis and prognosis prediction of pregnancy related acute kidney injury(RPAKI) of pregnant women.Methods:A total of 93 patients with RP-AKI (the RP-AKI group) were divided into the poor prognosis group (27 cases) and the eusemia groups (66 cases) according to the result of postpartum follow-up,another 100 cases of normal parturient were in the control group.The SCr levels was detected by sarcosine oxidase as say,serum Cys C level was detected by latex-enhanced immunoturbidimetric assay,serum NGAL level was detected by dual sandwich enzyme linked immunosorbent assay,risk factors for RP-AKI or poor prognosis were analyzed by logistic multiple regression,the diagnosis and prognosis prediction value of SCr,Cys C,NGAL for RP-AKI were evaluated by receiver operating curve (ROC).Results:The SCr,Cys C,NGAL level of patients in the RP-AKI group were significant higher than those of patients in the control group (P＜0.05).In 3 months,6 months,and 12 months post partum,the level of SCr,Cys C,and NGAL of patients in the poor prognosis group were significant higher than those of patients in the eusemia group (P＜0.05).Correlation analysis showed that for patients in RP-AKI group,there was positive correlation between serum SCr and Cys C (P＜0.05),serum SCr level was positively correlated with NGAL (P＜0.05),Cys C was positively correlated with NGAL (P＜0.05).Logistic regression analysis showed that level of SCr,Cys C and NGAL were independent risk factors for poor prognosis in patients with RP-AKI (P＜0.05).The optimal cut-off value of NGAL level as an indicator for diagnosing RP-AKI was 17.98μg/L,which yielded a sensitivity was 82.7％ and a specificity was 87.9％,and its area under the curve (AUC) was 0.946 (P＜0.05),the AUC of NGAL level for diagnosing RP-AKI was higher than that of SCr level (AUC:0.85,P＜0.05),Cys C level (AUC:0.82,P＜0.05).The optimal cut off value of SCr level as an indicator for diagnosing RP-AKI was 127.63μmol/L,which yielded a sensitivity was 79.4％ and a specificity was 83.1％,with AUC was 0.89 (P＜0.05),the AUC of SCr level predicted prognosis of RP-AKI was higher than that of Cys C level (AUC:0.75,P＜0.05),NGAL level (AUC:0.80,P＜0.05).Conclusion:The diagnostic value of NGAL for RP-AKI is higher than that of SCr and Cys C,and the prognostic prediction value of SCr for RP-AKI is higher than that of Cys C and NGAL.