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1、尿中性粒细胞明胶酶相关脂质运载蛋白在危重病患者急性肾损伤早期诊断中的意义【摘要】目的评估尿液中的中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)对监护病房(ICU)中危重病患者急性肾损伤(AKI)的预测价值。方法研究对象是分别来自三家综合性医院ICU的110例患者。患者均为18岁以上成年人,入ICU后连续观察72h,根据AKI诊断的REFLE标准将患者分为AKI组33例和非AKI组77例。根据脓毒症诊断标准将患者又分为脓毒症组79例和非脓毒症组31例。排除标准为慢性肾功能不全、恶性肿瘤、入ICU24h内死亡患者。每天检测患者的血肌酉干和uNGALo比较分析脓毒症与非脓毒症患者、AKI与非A
2、KI患者、脓毒症合并AKI与脓毒症非AKI患者之间uNGAL的差异,以及AKI与非AKI患者入ICU第24小时的血肌肝和uNGAL之间的差异,应用R0C曲线评价uNGAL和血肌酉干对ICU患者AKI诊断的敏感性和特异性。结果脓毒症与非脓毒症患者之间,AKI与非AKI患者之间,脓毒症合并AKI与脓毒症非AKI患者之间的uNGAL质量浓度差异具有统计学意义。在入ICU第24小时AKI与非AKI患者uNGAL质量浓度差异具有统计学意义,血肌肝浓度差异无统计学意义。患者入ICU第24小时的uNGAL和血肌酹的ROC曲线下面积分别为0.828(95%CI:0.742〜0.914)和0.583(95
3、%CI:0.471〜0.695)。uNGAL的cutoff值为170ng/ml,敏感性和特异性分别为0.778和0.784,敏感性优于血肌肝。结论uNGAL在诊断AKI方面优于血肌酉干,能够作为ICU患者AKI早期诊断的标志物。【关键词】中性粒细胞明胶酶相关脂质运载蛋白;血肌肝;脓毒症;急性肾损伤;敏感性;特异性EearlydiagnosticvalueofurinaryNGALinacutekidneyinjuryincriticallyillpatientsXUXingkai*,LIYan,YUMengjin,WANGXi,LINZhaofen,ZHANGLiandong,SHANH
4、ongwei・*TheEmergencyDepartmentoftheShanghaiSecondMilitaryMedicalUniversity,ChangzhengHospital,Shanghai200003,ChinaCorrespondingauthor:SHANHongwei,Email:shwshan@163・com;ZHANGLiandong,Email:zhang_ldl20@yahoo.com.cn[Abstract】ObjectiveToestimatethepredictivevalueofneutrophilgelatinaseassociatedlipoca
5、lininurine(uNGAL)fordetectionofacutekidneyinjury(AKI)intheintensivecareunit(ICU)criticallyillpatients.MethodsAtotalof110patientsfromtheICUofthreegeneralhospitalswereenrolledinthestudy.Thepatientswereadultsmorethan18yearsofage・AfteradmittedtoICU,thepatientswerecontinuouslyobservedfor72hours・Accord
6、ingtotheRIFLEcriteriafordiagnosisofAKI,thepatientswereclassifiedasAKIgroup(33cases)ornonAKI(77cases).Accordingtothesepsisdiagnosticcriteria,thepatientswereclassifiedassepsis(79cases)ornonsepsis(31cases).Exclusioncriteriaofpatientswerechronicrenalinsufficiency,malignanttumor,deathafteradmittedtoIC
7、U24hours・SerumcreatinineanduNGALofthepatientswereanalyzeddaily.ThedifferenceofuNGALbetweensepsisandnonsepsispatients,AKIandnonAKIpatients,sepsisnonAKIandsepsisAKIpatientswascompared・Moreover,thedifferenceofserumcreatin