摘要目的 评价血清和尿中性粒细胞明胶酶相关载质蛋白(NGAL)对脓毒症患者发生急性肾损伤(AKI)的预测价值.方法 本研究为前瞻性观察研究,于2014年7月1日至2014年12月31日在天津市人民医院、天津医院和天津南开医院三所医院进行,入选患者为不伴AKI的脓毒症患者.入选患者于入住重症监护室(ICU)后发生AKI者归入AKI组,未发生AKI者归入非AKI组.患者入住ICU后,立即采血、尿标本以及临床数据,于入住ICU后的12、24、36、48、60、72、84和96 h连续采集血清和尿液标本.血清和尿标本检测肌酐(Cr)和NGAL.符合正态分布的计量资料数据比较用成组t检验或重复测量的方差分析;非正态分布计量资料数据比较用Mann-Whitney U检验或Fridman检验.计数资料数据比较用Fisher精确概率法.用受试者工作曲线(ROC)分析血清NGAL(sNGAL)和尿NGAL(uNGAL)对AKI发生的预测价值.结果 50例脓毒症患者入选,AKI组35例,非AKI组15例,两组患者年龄的中位数(四分位数)分别为AKI组73岁(66,83)岁,非AKI组60岁(47,82)岁.在各个时间点处,AKI组的uNGAL浓度显著高于非AKI组;而AKI组的sNGAL浓度只在AKI发生前的48 h和36 h高于非AKI组.AKI发生前48 h、36 h、24 h和12 h的uNGAL预测AKI发生的ROC曲线下面积(AuROC)分别为0.83(95%CI:0.70~0.97)、0.75(95%CI:0.59~0.91)、0.83(95%CI:0.70~0.95)和0.73(95% CI:0.60~0.88).sNGAL只在AKI发生前的48 h和36 h具有预测AKI的能力,AuROC值分别为0.69(95%CI:0.51~0.88)和0.69(95%CI:0.52~0.87).结论 sNGAL和uNGAL均是预测AKI有效的早期生物标志物,但sNGAL预测AKI的价值稍逊于uNGAL.

abstractsObjective To assess the capability of serum and urine neutrophil gelatinase-associated lipocalin (NGAL) in predicting acute kidney injury (AKI) in septic patients.Methods From July 1, 2014 through December 31, 2014, a prospective observational study of septic patients without AKI was carried out in Renmin Hospital, Tianjin Hospital, and Nankai Hospital, Tianjin.The patients with AKI which was developed after admission to intensive care unit (ICU) were assigned to AKI group and the patients without AKI were assigned to non-AKI group.Clinical data and serum and urine sample were collected at the admission, and at 12, 24, 36, 48, 60, 72 ,84 and 96 hours after admission for detecting creatinine and NGAL.The measurement data accorded with normal distribution were used for t test or variance analysis of repeated measures;comparison of measurement data in non-normal distribution was carried out using the Mann-Whitney U test or Fridman test;comparison of count data was performed using Fisher exact probability method.ROC curve of serum or urine NGAL was plotted and the diagnostic values of serum or urine NGAL in predicting AKI were assessed by calculation of the area under the receiver operating characteristic curve (AuROC).Results Fifty septic patients were included.Thirty-five patients were in AKI group and fifteen in non-AKI group.The median age of AKI group was 73 and the median age of non-AKI group was 60 (IQR, 47-82).The urine NGAL (uNGAL) concentration in AKI group was higher than that in non-AKI group at the every interval and serum NGAL (sNGAL) was higher in AKI group than that in non-AKI group at only first twointervals.The uNGAL showed the capability of prediction for AKI progression at the 48 hour (AuROC=0.83,95% CI:0.70-0.97), 36 hours (AuROC=0.75,95%CI:0.59-0.91), 24 hours (AuROC=0.83,95%CI:0.70-0.95), 12 hours (AuROC=0.73,95%CI:0.60-0.88) prior to AKI occurred.The sNGAL showed capability of prediction at the 48 hours (AuROC=0.69,95%CI:0.51-0.88), 36 hours (AuROC=0.69,95%CI:0.52-0.87) prior to AKI occurred.Conclusions The sNGAL and uNGAL both were useful biomarker that predicted development of AKI in early stage.But the performance of sNGAL was slightly inferior to that of uNGAL for predicting development of AKI.