尿中性粒细胞明胶酶相关脂质运载蛋白在脓毒症患者急性肾损伤中的临床价值

何再明; 吴颖; 党宗彦; 孙赟; 范娟

doi:10.13201/j.issn.1009-5918.2017.04.007

尿中性粒细胞明胶酶相关脂质运载蛋白在脓毒症患者急性肾损伤中的临床价值

- 上海市普陀区利群医院急诊医学科
基金项目:
上海市普陀区科委卫生系统自主创新科研基金项目 (No:KW-2014-01)

详细信息

通讯作者: 何再明, E-mail:hzm9292@163.com

中图分类号: R631

收稿日期: 2017-02-15

Diagnostic and prognostic value of urinary neutrophil gelatinase-associated lipocalin in septic patients with acute kidney injury

- Department of Emergency, Liqun Hospital, Shanghai 200333, China

More Information

Corresponding author: HE Zaiming, E-mail: hzm9292@163.com

Received Date: 15 February 2017

摘要

摘要: 目的: 观察并探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)在脓毒症患者急性肾损伤(AKI)早期诊断、诊断分层、预后中的临床价值。方法: 纳入2014-07-2016-06我院急诊科收治的、符合脓毒症标准的患者240例。按照AKIN定义分为脓毒症AKI组(124例)和脓毒症非AKI组(116例);此外,选取同期在我院体检的健康对照组30例。分别收集2组患者入急诊0、6、12、24、48 h尿液标本进行NGAL检测,并同时收集2组患者0、24、48 h血肌酐以及入急诊时的血降钙素(PCT)、乳酸、C反应蛋白(CRP)、SOFA评分等临床指标。结果: 与健康对照组对比,脓毒症AKI组和脓毒症非AKI组患者uNGAL、乳酸、PCT等指标均升高;相对脓毒症非AKI组,脓毒症AKI组患者uNGAL、血肌酐、血乳酸、PCT水平、SOFA评分更高(P<0.05),且住院天数延长(P<0.05)。脓毒症AKI组患者的uNGAL水平随AKI 1期、2期、3期分期依次递增、且随病程时间变化逐渐上升(P<0.05);脓毒症非AKI组患者入院48 h后新增22例AKI患者(19.1%);与脓毒症非AKI患者相比,血肌酐水平从24 h后开始升高,48 h升高更显著;而uNGAL水平则从入急诊室时已明显升高(P<0.05);uNGAL诊断AKI曲线下面积为0.838(95%CI:0.732~0.947),最佳临界值179 μmol/L,敏感度和特异度为0.727和0.713。使用uNGAL预测脓毒症患者28 d死亡,以uNGAL 48 h ROC曲线下面积最大为0.818(95%CI:0.758~0.877)、最佳截断值为375 ng/ml,敏感度和特异度分别为0.747和 0.746。结论: uNGAL可能对脓毒症患者AKI具有一定的诊断、分期、预测结局的价值。
- 脓毒症 /
- 急性肾损伤 /
- 尿中性粒细胞明胶酶相关脂质运载蛋白 /
- 早期诊断 /
- 分期 /
- 预后
Abstract: Objective: To observe and investigate the clinical value of neutrophil gelatinase-associated lipocalin (NGAL) in urine in early diagnosis,diagnosis and prognosis of acute renal injury (AKI) in patients with sepsis. Method: Two hundred and forty patients with sepsis from July 2014 to June 2016 were treated in our hospital emergency department According to the definition of AKIN all patients were divided into septic AKI group (n=124) and septic non-AKI group (n=116);Urine samples were collected at 0,6,12,24 and 48 h after the entrance of the emergency department for NGAL detection.And we also recorded serum creatinine,calcitonin (PCT),lactic acid,c-reactive protein (CRP),SOFA score at the same time. Result: Compared with healthy control group,uNGAL,lactic acid,and PCT of patients in the experimental septic AKI group and experimental septic non-AKI group were elevated.The level of uNGAL、serum creatinine、blood lactic acid、PCT and SOFA score were higher in the experimental septic AKI group than those in septic non-AKI group (P<0.05),the levels of uNGAL in experimental septic AKI group increased according to the order of AKI 1,2 and 3,and gradually increased with the course of disease (P<0.05);In the experimental septic non-AKI group,22 patients with AKI (19.1%) were enrolled after 48 h of admission;and the serum creatinine levels increased obviuosly after 24 h compared with non-AKI patients with sepsis;The level of the uNGAL were significantly higher than those of the control group (P<0.05) when they enter Emergency room.The areas under the AKI curve was 0.838(95%CI:0.732~0.947).The optimal threshold was 179 μmol/L,and the sensitivity and specificity of the uNGAL were 0.727 and 0.713.When using uNGAL to predict sepsis in patients with 28-day mortality,the area under the curve of uNGAL 48 h ROC was 0.818 (95%CI:0.758~0.877),and the maximum cutoff was 375 ng/ml,and the sensitivity and specificity were 0.747 and 0.746.Conclusion: Urine NGAL may have clinical application value of a certain diagnosis,staging,predicting the clinical outcome in the sepsis patients with AKI.
- sepsis /
- acute renal injury /
- urinary NGAL /
- early diagnosis /
- staging and prognosis /

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