建立NGAL诊断阈值有利于临床判断和发现急性肾功能损伤

为探讨中性粒细胞相关载脂蛋白(neutrophil gelatinase-associated lipocalin, NGAL)检测在肝胆疾病患者继发急性肾功能损伤(acute kidney injury, AKI)中的诊断性能,本研究回顾性收集了476例肝胆疾病患者与225例健康受试者作为实验组,根据血清中性粒细胞相关载脂蛋白(NGAL)、血清肌酐(serum creatinine,s Cr)、尿素(Urea)、半胱氨酸蛋白酶抑制剂C (cystatin C, CysC)、估算肾小球滤过率(estimating glomerular filtration rate, eGFR)水平和尿量,分为急性肾功能损伤(AKI)组和高风险(high-risk, HR)组、低风险(low-risk,LR)组和对照(health control, HC)组,进而建立上述血清指标在急性肾功能损伤(AKI)诊断性能最大时的判断界值;随后,选取145例肝胆疾病患者作为验证组,以评估各观察指标对肝胆疾病继发急性肾功能损伤(AKI)的诊断性能。结果表明:本实验组中各亚组间所观察指标之血清水平均有统计学差异(p<0.05)。中性粒细胞相关载脂蛋白(NGAL)诊断性能最大时的判断界值为205.2μg/L。验证组患者各指标阳性检出率,在低风险(LR)亚组中中性粒细胞相关载脂蛋白(NGAL)均高于其它指标(p<0.05),但在高风险(HR)亚组中中性粒细胞相关载脂蛋白(NGAL)仅高于血清肌酐(sCr)(p<0.05),而与半胱氨酸蛋白酶抑制剂C (CysC)和估算肾小球滤过率(eGFR)无统计学差异(p>0.05);再经分层风险分析各指标预测高风险(HR)亚组患者急性肾功能损伤(AKI)发生的能力,中性粒细胞相关载脂蛋白(NGAL)的优势比(OR=21.0 (2.3, 192.8)),是半胱氨酸蛋白酶抑制剂C(CysC)或估算肾小球滤过率(eGFR)(OR (95%CI)=3.3 (0.7, 15.3))的6.4倍。本研究初步结论表明,肝胆疾病患者诊断急性肾功能损伤(AKI)时应考虑中性粒细胞相关载脂蛋白(NGAL)肝脏合成代谢的作用。因此实验室应建立适宜的中性粒细胞相关载脂蛋白(NGAL)诊断阈值以有利于临床准确判断及早期发现急性肾功能损伤(AKI)。

The Establishment of Diagnostic Threshold for Neutrophil Gelatinase-associated Lipocalin was Helpful for Clinical Judgment and Discovery of Acute Kidney Injury

To investigate the diagnostic performance of neutrophil gelatinase-associated lipocalin(NGAL)in patients with hepatobiliarydisease secondaryacute kidneyinjury(AKI),this studyretrospectivelycollected 476 patients with hepatobiliary disease and 225 healthy subjects as experimental group,and then divided them into AKI group,high-risk group(HR),low-risk group(LR)and health control group(HC)accordingto their serum neutrophil gelatinase-associated lipocalin(NGAL),serum creatinine(sCr),Urea,cystatin C(CysC),estimating glomerular filtration rate(eGFR)and urinary production.Next,their judgment threshold of the above serum indicators at maximum diagnostic performance of AKI was established.Subsequently,145 patients with hepatobiliary disease were selected as the verification group to evaluate the diagnostic performance of each observation index on AKI secondary to hepatobiliary disease.These results showed that there were significant differences in the serum levels of the observed indicators among the subgroupsin the experimental group(p<0.05).The diagnostic performance for NGAL was 205.2 μg/L when the diagnostic performance of neutrophil-associated apolipoprotein(NGAL)was maximum.For the positive detection rates in the validation group,NGAL was higher than other indexes in LR subgroup(p<0.05),but NGAL in HR subgroup was only higher than sCr(p<0.05),and there was no statistical difference with CysC and eGFR(p>0.05).The abilityof various indicators for predicting the occurrence of AKI in HR subgroup was analyzed by hierarchical risk analysis,the dominance ratio of NGAL(OR=21.0(2.3,192.8))was 6.4 times higher than that of CysC or eGFR(OR(95% CI)=3.3(0.7,15.3)).The preliminary conclusions of this study indicated that the effect of NGAL in liver synthesis and metabolism should be considered in the diagnosis of AKI in patients with hepatobiliary diseases.Therefore,the laboratory should establish a suitable diagnostic threshold for NGAL to facilitate accurate clinical judgment and earlydetection ofofAKI.