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目的探讨中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)联合胱抑素C(cystatin C,Cys C)对脓毒症相关急性肾损伤(acute kidney injury,AKI)的早期诊断学意义。方法连续性收录脓毒症患者80例,其中36例患者出现AKI(AKI组),44例患者未出现AKI(单纯脓毒症组)。综合分析入重症监护室(intensive care unit,ICU)时和诊断AKI时/入ICU第7天时血尿NGAL和血尿Cys C水平改变及其临床预测诊断价值。结果诊断AKI当天AKI组患者血NGAL、尿NGAL、血Cys C和尿Cys C明显升高(P<0.05)。入ICU时AKI组血NGAL和尿NGAL均高于单纯脓毒症组(P<0.05)。入ICU时,血NGAL、尿NGAL与AKI(r_(血NGAL)=0.558,r_(尿NGAL)=0.442,P<0.05)和28 d死亡率(r_(血NGAL)=0.589,r_(尿NGAL)=0.601,P<0.05)密切正相关,血NGAL与C反应蛋白(C-reactive protein,CRP)(r=0.449,P<0.05)、ICU平均住院时间(r=0.632,P<0.05)正相关。入ICU当天血NGAL预测AKI的AUC为0.722,P<0.05,cut-off值为354.3μg/L,敏感性为77.5%,特异性为83.2%。结论脓毒症相关AKI患者早期可出现不同程度的血尿NGAL升高,其中血NGAL水平对于脓毒症相关AKI具有较好的预警价值。
Objective To investigate the early diagnosis of acute kidney injury (AKI) associated with neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C) Significance of learning. Methods Seventy patients with sepsis were included in succession. Among them, AKI was found in 36 patients and AKI was not found in 44 patients (simple sepsis group). The changes of hematuria NGAL and hematuria Cys C at the time of intensive care unit (ICU) and AKI at diagnosis / admission to ICU on the 7th day after ICU analysis and their clinical predictive value were analyzed. Results AKI, urinary NGAL, blood Cys C and urinary Cys C were significantly increased in AKI patients on AKI day (P <0.05). Into the ICU AKI group blood NGAL and urine NGAL were higher than the simple sepsis group (P <0.05). Into the ICU, blood NGAL, urinary NGAL and AKI (blood NGAL = 0.558, urinary NGAL = 0.442, P <0.05) and 28 d mortality (blood NGAL = 0.589, (R = 0.449, P <0.05), ICU mean length of stay (r = 0.632, P <0.05), positive rate of CRP (r = 0.632, P <0.05) Related. On the day of ICU, the AUC of blood NGAL predicted AKI was 0.722, P <0.05, the cut-off value was 354.3μg / L, the sensitivity was 77.5% and the specificity was 83.2%. Conclusions In the sepsis-associated AKI patients, different degrees of hematuria and NGAL increase may occur in early stage. The blood NGAL level has a good early warning value for sepsis-related AKI.