摘要
目的:探讨血清和尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在预测感染性休克患者继发急性肾损伤(AKI)中的意义。方法:选择2016-05—2017-10期间收住我院重症医学科,符合感染性休克标准的患者295例。依据2012年KDIGO更新的AKI的诊断标准将入选患者分为AKI组(136例)和非AKI组(159例)。检测并比较两组患者入科后6h内血NGAL、尿NGAL、血肌酐等指标。绘制ROC曲线,确定NGAL的检测临界值以及对早期预测感染性休克患者继发急性肾损伤(AKI)的意义。结果:AKI组患者血肌酐、血NGAL、尿NGAL分别为(150±50)μmol/L、(239±147)ng/ml、(374±230)ng/ml,非AKI组患者分别为(75±32)μmol/L、(158±112)ng/ml、(353±275)ng/ml,AKI组患者的血肌酐、血NGAL水平显著高于非AKI组患者(均P<0.05),而两组尿NGAL水平的比较差异无统计学意义(P>0.05)。ROC曲线分析,血肌酐曲线下面积为0.918,95%可信区间为0.865~0.970,敏感度88.9%,特异度81.4%,截断值为102.5μmol/L;血NGAL曲线下面积为0.667,95%可信区间为0.551~0.783,敏感度72.2%,特异度63.9%,截断值为138.5ng/ml。结论:血NGAL在预测感染性休克患者AKI的发生上表现出一定的敏感度和特异度,具备一定的临床早期诊断价值,尿NGAL在早期预测感染性休克患者AKI的发生上无明显临床价值。
Objective：To investigate the predictive value of serum neutrophil gelatinaseassociated lipocalin（sNGAL）and urine neutrophil gelatinase-associated lipocalin（uNGAL）as early biomarkers for acute kidney injury（AKI）in patients with septic shock.Method：Two hundred and ninety-five patients with septic shock admitted to the department of intensive medicine in Subei People＇s Hospital from May 2016 to October 2017 were enrolled in the study.All patients were divided into the AKI group（136 cases）and non-AKI group（159 cases）according to the diagnostic criteria for AKI defined by KDIGO AKI Guideline Work Group in 2012.The levels of sNGAL,uNGAL,serum creatinine were measured and compared in the two groups within 6 hours after the admission.The cutoff value of sNGAL and uNGAL were determined and their value was evaluated on patients with septic shock and AKI in early diagnosis by ROC curve.Result：The serum creatinine,sNGAL and uNGAL in the AKI group were（150 ±50）μmol/L,（239 ± 147）ng/ml,（374 ± 230）ng/ml,respectively,and in the non-AKI group were（75 ± 32）μmol/L,（158 ± 112）ng/ml,（353 ± 275）ng/ml,respectively.The levels of sNGAL,serum creatinine in the AKI group were much higher than those in the non-AKI group（all P〈0.05）,but the levels of uNGAL showed no significant differences in the two groups（P〉0.05）.The areas of serum creatinine,sNGAL under the ROC curve to evaluated their value on patients with septic shock and AKI in early diagnosis were 0.918,0.667,respectively,the cutoff value were 102.5μmol/L,138.5 ng/ml,respectively,the diagnostic sensitivity were 88.9%,72.2%,respectively,and specificity were 81.4%,63.9%,respectively.Conclusion：SNGAL show a certain degree of sensitivity and specificity in predicting septic shock patients secondary to AKI at the early stage.UNGAL show no significant clinical value in predicting septic shock patients secondary to AKI at the early stage.
作者
赵仁淹
郑瑞强
ZHAO Renyan;ZHENG Ruiqiang(Department of Critical Care Medicine,Northern Jiangsu People＇s Hospital,Jiangsu,Yangzhou,225001,China)
出处
《临床急诊杂志》
CAS
2018年第7期443-446,共4页
Journal of Clinical Emergency
