血、尿中性粒细胞明胶酶相关脂质运载蛋白与胱抑素C对肝硬化并发急性肾损伤的诊断价值

许长红; 江坤仁

doi:10.3969/j.issn.1001-5256.2017.11.017

血、尿中性粒细胞明胶酶相关脂质运载蛋白与胱抑素C对肝硬化并发急性肾损伤的诊断价值

DOI: 10.3969/j.issn.1001-5256.2017.11.017

1. 武汉市汉南区红十字会医院内科
2. 武汉市汉南区人民医院内科

详细信息

中图分类号: R575.2;R692.5
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出版历程
- 收稿日期: 2017-05-10
- 出版日期: 2017-11-20

Value of serum and urinary neutrophil gelatinase-associated lipocalin and cystatin C in diagnosis of liver cirrhosis complicated by acute kidney injury

Department of Internal Medicine, The Red Cross Hospital of Hannan District

摘要

摘要: 目的检测血、尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C（CysC）水平,分析其对肝硬化患者并发急性肾损伤（AKI）的早期诊断价值。方法选择2015年1月-2017年3月于武汉市汉南区红十字会医院就诊的肾功能正常的肝硬化患者236例,依据入院后48 h内是否并发AKI分为AKI组78例,非AKI组158例,选择同期健康体检者100例为对照组。采用ELISA法检测血清NGAL（sNGAL）和尿液NGAL（uNGAL）及血清CysC浓度,并将血肌酐（SCr）浓度和肾小球滤过率（GFR）进行组间比较。计量资料多组间比较采用单因素方差分析,进一步两组间比较采用SNK-q检验;相关分析采用Pearson相关分析法;利用受试者工作特征曲线（ROC曲线）分析相关指标的诊断价值。结果入院48 h,AKI组sNGAL、uNGAL、CysC同非AKI组和对照组相比,差异均有统计学意义（P值均<0.05）;将AKI组依照肾损伤标准进行分期,分期高的患者sNGAL、uNGAL浓度显著高于分期低的患者,差异均有统计学意义（P值均<0.05）;与入院前比较,入院6 h时sNGAL、uNGA...
- 肝硬化 /
- 肾功能不全,急性 /
- 中性粒细胞明胶酶相关脂质运载蛋白 /
- 胱抑素C /
- 诊断
Abstract: Objective To investigate the value of serum neutrophil gelatinase-associated lipocalin (sNGAL) , urinary neutrophil gelatinase-associated lipocalin (uNGAL) , and serum cystatin C (CysC) in the early diagnosis of acute kidney injury (AKI) in patients with liver cirrhosis.Methods A total of 236 patients with liver cirrhosis and normal renal function who visited The Red Cross hospital of Hannan District from January 2015 to March 2017 were enrolled, and according to the presence or absence of AKI within 48 hours after admission, these patients were divided into AKI group with 78 patients and non-AKI group with 158 patients.Another 100 healthy subjects who underwent physical examination were enrolled as control group.ELISA was used to measure sNGAL, uNGAL, and serum CysC, and serum creatinine (SCr) and glomerular filtration rate (GFR) were compared between groups.A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the SNK-q test was used for further comparison between two groups.A Pearson correlation analysis was also performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these indices.Results At 48 hours after admission, there were significant differences in sNGAL, uNGAL, and CysC between the AKI group and the non-AKI group/control group (all P<0.05) .The patients in the AKI group were stratified by AKI stage based on the criteria for kidney injury, and the patients with a higher stage had significantly higher levels of sNGAL and uNGAL than those with a lower stage (both P<0.05) .The levels of sNGAL, uNGAL, and CysC started to increase at 6 hours after admission, while Scr and GFR started to change at 48 hours after admission, i.e., sNGAL and uNGAL increased significantly earlier than Scr and GFR (P<0.05) .In the AKI group, sNGAL, uNGAL, and CysC were positively correlated with SCr (r=0.650, 0.681, and 0.581, all P<0.05) .According to the ROC curve analysis, sNGAL had an area under the ROC curve (AUC) of 0.845±0.435, an optimal cut-off value of 542.68 μg/L, a sensitivity of 0.824, and a specificity of 0.794, uNGAL had an AUC of 0.836±0.326, an optimal cut-off value of 75.12 μg/L, a sensitivity of 0.816, and a specificity of 0.766, and CysC had an AUC of 0.818±0.267, an optimal cut-off value of 1.48 mg/L, a sensitivity of 0.808, and a specificity of 0.732.Conclusion NGAL and CysC can be used as indices for the early diagnosis of AKI and have great significance in evaluating renal injury and developing treatment measures for patients with liver cirrhosis.
- liver cirrhosis /
- renal insufficiency, acute /
- neutrophil gelatinase-associated lipocalin /
- cystatin C /
- diagnosis

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参考文献(18)

[1]BELCHER JM.Acute kidney injury in liver disease:role of biomarkers[J].Adv Chronic Kidney Dis, 2015, 22 (5) :368-375.

[2]FIRU SG, STREBA CT, FIRU D, et al.Neutrophil gelatinaseassociated lipocalin (NGAL) -a biomarker of renal dysfunction patients with liver cirrhosis:do we have enough proof[J].J Med Life, 2015, 8 (Suppl 1) :15-20.

[3]NADKARNI GN, SIMOES PK, PATEL A, et al.National trends of acute kidney injury requiring dialysis in decompensated cirrhosis hospitalizations in the United States[J].Hepatol Int, 2016, 10 (3) :525-531.

[4]WAN ZH, WANG JJ, XIE GM, et al.Significance of serum cystatin C level for early diagnosis of acute kidney injury in patients with acute-on-chronic liver failure[J].J Clin Hepatol, 2014, 30 (7) :666-669. (in Chinese) 万志红, 王建军, 谢国明, 等.血清胱抑素C对慢加急性肝衰竭患者肾损伤的早期诊断意义[J].临床肝胆病杂志, 2014, 30 (7) :666-669.

[5]PATEL ML, SACHAN R, VERMA A, et al.Neutrophil gelatinase-associated lipocalin as a biomarker of disease progression in patients with chronic kidney disease[J].Indian J Nephrol, 2016, 26 (2) :125-130.

[6]QU AH, WANG YG, WANG LY, et al.The value of Cystatin C for assessing condition of acute kidney injury in patients with liver cirrhosis[J].Acta Acod Med Qingdao Univ, 2016, 52 (3) :325-328. (in Chinese) 曲爱华, 王义国, 汪丽云, 等.胱抑素C对肝硬化急性肾损伤病情评估的价值[J].青岛大学医学院学报, 2016, 52 (3) :325-328.

[7]ZHANG SE.Diagnostic criteria and treatment options for cirrhosis[J].Mod J Integr Tradit Chin West Med, 2002, 11 (10) :953-954. (in Chinese) 张书娥.肝硬化的诊断标准和治疗方案[J].现代中西医结合杂志, 2002, 11 (10) :953-954.

[8]JI LJ, QIAN ZP, WANG JF.Advances in early diagnosis of acute renal injury due to cirrhosis[J].Chin Hepatol, 2016, 21 (12) :1081-1084. (in Chinese) 纪留娟, 钱志平, 王介非.肝硬化急性肾损伤早期诊断的研究进展[J].肝脏, 2016, 21 (12) :1081-1084.

[9]ZANG H, WAN ZH, XIN SJ.Early clinical diagnosis of liver cirrhosis with acute kidney injury[J].Chin J Infect Dis, 2015, 33 (9) :566-568. (in Chinese) 臧红, 万志红, 辛绍杰.肝硬化急性肾损伤的早期临床诊断[J].中华传染病杂志, 2015, 33 (9) :566-568.

[10]LUO JH, WU N.Value of serum kidney injury molecule-1 level in early predicting renal dysfunction secondary to liver cirrhosis[J].Lab Med Clin, 2015, 12 (2) :188-190. (in Chinese) 罗俊华, 吴娜.肾损伤分子-1对肝硬化继发肾功能损害早期预测的价值[J].检验医学与临床, 2015, 12 (2) :188-190.

[11]PU CW, WANG BY, QIAO L, et al.Recent progress in research of biomarkers of acute kidney injury in liver cirrhosis[J].Chin J Hepatol, 2013, 21 (10) :796-798. (in Chinese) 蒲春文, 王炳元, 乔梁, 等.肝硬化并发急性肾损伤标志物的研究进展[J].中华肝脏病杂志, 2013, 21 (10) :796-798.

[12]NAYAK NM, MADHUMITHA S, ANNIGERI RA, et al.Clinical utility of urine neutrophil gelatinase-associated lipocalin measured at admission to predict outcomes in heterogeneous population of critically ill patients[J].Indian J Nephrol, 2016, 26 (2) :119-124.

[13]HONORE PM, SPAPEN HD.Neutrophil gelatinase-associated lipocalin elimination by renal replacement therapy:minding the membrane![J].Crit Care, 2016, 20 (1) :87.

[14]LIU HJ, WANG P, SHEN YL, et al.Combination of urine neutrophil gelatinase lipocalin associated lipocalin, kidney injury molecular-1and interleukin-18 in the diagnosis of acute kidney injury in children after cardiopulmonary bypass[J].J Clin Pediatr, 2014, 32 (6) :517-523. (in Chinese) 刘华杰, 王平, 沈云琳, 等.中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子1和白介素18在诊断心肺分流术后急性肾损伤中的意义[J].临床儿科杂志, 2014, 32 (6) :517-523.

[15]DU W, XING JY, SUN YB, et al.Effects of timing of renal replacement therapy on outcomes in patients with acute kidney injury:a meta analysis[J].Acta Acad Med Qingdao Univ, 2015, 51 (3) :341-344. (in Chinese) 杜伟, 邢金燕, 孙运波, 等.RRT时机对急性肾损伤病人预后影响的Meta分析[J].青岛大学医学院学报, 2015, 51 (3) :341-344.

[16]PENG HY, ZONG XX, PEI L.Diagnostic value of combined detection of serum cystatin C and microalbuminuria in diabetic patients with early renal injury[J].Chin J Med Offic, 2015, 43 (6) :648-649. (in Chinese) 彭海英, 宗先旭, 裴莉.血清胱抑素C和尿微量白蛋白联合检测在糖尿病患者早期发现肾损伤中的诊断价值[J].临床军医杂志, 2015, 43 (6) :648-649.

[17]ZHAO W.Clinical significance of plasma and urine neutrophil gelatinase-associated lipocalin levels in diagnosis of acute kindney injury in patients with cirrhosis[J].J Clin Hepatol, 2015, 31 (11) :1874-1877. (in Chinese) 赵炜.血、尿中性粒细胞明胶酶相关脂质运载蛋白对肝硬化急性肾损伤的诊断价值[J].临床肝胆病杂志, 2015, 31 (11) :1874-1877.

[18]GE B, LIU Y, FENG JF, et al.Research progress of NGAL in the diagnosis of acute renal injury in patients with liver cirrhosis[J].Int JLab Med, 2017, 38 (4) :508-510. (in Chinese) 葛斌, 刘艳, 俸家富, 等.NGAL在诊断肝硬化患者急性肾功能损伤中的研究进展[J].国际检验医学杂志, 2017, 38 (4) :508-510.

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