摘要
目的 探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）和肝型脂肪酸结合蛋白（L-FABP）在肝移植术后急性肾损伤（AKI）中的早期诊断价值.方法 前瞻性收集2007至2008年间25例肝移植患者术前、门静脉开放后2、4、6、12、24、48、72和120 h的血液和尿液标本,检测Scr和尿NGAL及L-FABP水平.根据急性肾损伤网（AKIN）标准中的Scr标准将患者分为AKI组和非AKI组.观察两组各时间点尿NGAL、尿L-FABP和Scr水平的动态变化;运用受试者工作特征曲线（ROC）评价尿NGAL和L-FABP诊断A KI的精确性.结果 25例患者中11例发生了术后AKI,两组患者术前、术中及术后情况差异无统计学意义.术后24 hAKI组与非AKI组的Scr差异有统计学意义[（90.48±50.32）比（59.84±14.72）μmol/L,P＜0.05].AKI组与非AKI组术后2～120 h尿L-FABP均显著升高,4 h时差异有统计学意义[2361.41（1036.89～4048.93）ng/mgCr比5246.97（2406.33～7688.21）ng/mgCr,P＜0.05].AKI组术后2、4、6 h尿NGAL均显著高于非AKI组,差异有统计学意义[69.02（29.79～237.29）比22.94（8.69～46.23）ng/mgCr,29.34（16.06～536.91）比12.66（8.91～22.78）ng/mgCr和34.23（11.47～81.26）比11.84（6.57～20.10）ng/mgCr,均P＜0.05].ROC曲线下面积（AUC）结果显示,与尿L-FABP相比（当4 h截断点为3451.75 ng/mgC时,AUC为0.760）,尿NGAL对早期诊断AKI具有更高的敏感性和特异性（2、4、6 h的截断点分别为43.02、26.97和17.19 ng/mgCr时,AUC分别为0.766、0.773和0.773）.结论 尿NGAL在肝移植术后早期AKI的诊断上表现出较高的敏感性和特异性,也许能作为肝移植术后AKI早期诊断的生物学标志物,但仍需要大样本的临床研究加以证实.
Objective To investigate the value of urinary neutrophil gelatinase-associated lipocalin （NGAL） and liver-type fatty acid-binding proteins （L-FABP） in early diagnosis of acute kidney injury （AKI） after liver transplantation. Methods During 2007-2008, 25 liver transplant recipients were recruited. Blood and urinary samples were collected before operation and at 2, 4, 6,12, 24, 48, 72, 120 h after portal vein opening, and used to determine serum creatinine （Scr）, as well as urinary NGAL and L-FABP, which were normalized to urinary creatinine. According to the Acute Kidney Injury Network （AKIN） criteria of AKI, all the patients were divided into AKI and non-AKI groups. Standard statistics were used along with ROC analysis to evaluate the diagnose value of selected markers. Results There were no significant differences in clinical parameters between non-AKI （n=14） and AKI （n=11） groups. Both groups had a transient rise in Scr 2-12 hours after surgery, but the rise lasted longer in AKI patients （2-24 hours）. While urinary L-FABP rose transiently in both groups 2-120 hours following surgery, urinary NGAL was only slightly elevated at 2 h in the non-AKI group, but rose and stayed high from 2 to 6 h in the AKI group.ROC analysis revealed that NGAL （cut-off 43.02, 26.97 and 17.19 ng/mgCr, AUC 0.766, 0.773 and 0.773 at 2, 4 and 6 h, respectively） was better than L-FABP （cut-off 3451.75 ng/mgCr, AUC 0.760 at 4 h）. Conclusion Urinary NGAL appears to be a sensitive and specific marker of AKI in liver transplant recipients, but these data need to be validated in larger prospective studies.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2010年第11期818-823,共6页
Chinese Journal of Nephrology
基金
上海市医学发展基金重点研究课题（2003ZD001）
上海市医药卫生基金（2007-135）
