探讨血清NGAL和Cys-C检测对危重病患者急性肾损伤的临床价值
|
摘要
目的:探讨血清中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase associated lipocalin,NGAL)和胱抑素C(Cystatin C,Cys-C)检测对辅助诊断危重病患者急性肾损伤的临床意义,为临床诊治提供参考依据。方法:使用前瞻性研究选择2015年2月-2016年5月本院ICU病房收治的120例危重病患者设为研究组,按照急性肾损伤诊断的RIFLE肌酐标准可将患者分为急性肾损伤组和非急性肾损伤组,分别检测血清NGAL、Cys-C和肌酐(Creatinine,Crea)浓度水平,对结果进行综合分析。结果:患者初入ICU病房时,急性肾损伤组和非急性肾损伤组患者的血清NGAL、Cys-C结果差异无统计学意义(P>0.05),但第24、48和72小时急性肾损伤组患者的血清NGAL、Cys-C结果显著高于非急性肾损伤组,差异具有统计学意义(P<0.05)。急性肾损伤组患者第24、48和72小时检测血清NGAL、Cys-C的阳性检出率均明显高于入ICU即刻,差异具有统计学意义(P<0.05),第24小时联合检测血清NGAL、Cys-C阳性检出率明显高于单项指标阳性检出率,差异具有统计学意义(P<0.05),但入ICU即刻、第48小时和第72小时差异无统计学意义(P>0.05)。结论:血清NGAL、Cys-C指标对危重病患者急性肾损伤早期辅助诊断、病情监测和预后效果判断都有积极的临床意义,联合检测适用于早期肾损伤的筛查,能有效提高患者检出率。
Objective:To explore the clinical significance of the acute kidney injury diagnosis of the critically ill patients by the NGAL and Cys-C testing,providing the reference for clinical diagnosis and treatment.Methods:Choosing 120 cases of critically ill patients for the experimental group,according to the RIFLE creatinine standard for diagnosis of acute kidney injury we divided the experimental group into the acute kidney injury group and non acute kidney injury group,testing the serum NGAL,Cys-C and Crea concentration level,analyze the results comprehensively.Results:Into the ICU immediately,there were no significantly difference of the patients were divided into the sepsis group and the non sepsis group showing that,there were no significantly difference of the NGAL and Cys-C between the acute kidney injury group and non acute kidney injury group(P>0.05),but there was significantly higher of the acute kidney injury group than the non acute kidney injury group of the NGAL and Cys-C at 24 th hour,48 th hour and 72 th hour(P<0.05).There were much higher of the positive detection rate of the NGAL and Cys-C at 24 th hour,48 th hour and 72 th hour than the ICU immediately in the acute kidney injury group(P<0.05),there was much higher of the positive detection rate of the NGAL and Cys-C at 24 th hour by joint detection than separate detection(P<0.05),but not for the ICU immediately,48 th hour and 72 th hour(P>0.05).Conclusion:There has positive clinical value for the early acute kidney injury diagnosis,condition monitoring and prognostic evaluation of the critically ill patients by the NGAL and Cys-C testing,and it can effectively improve the positive detection rate by the NGAL and Cys-C joint detection,and apply to screening fo the early acute kidney injury.
Objective:To explore the clinical significance of the acute kidney injury diagnosis of the critically ill patients by the NGAL and Cys-C testing,providing the reference for clinical diagnosis and treatment.Methods:Choosing 120 cases of critically ill patients for the experimental group,according to the RIFLE creatinine standard for diagnosis of acute kidney injury we divided the experimental group into the acute kidney injury group and non acute kidney injury group,testing the serum NGAL,Cys-C and Crea concentration level,analyze the results comprehensively.Results:Into the ICU immediately,there were no significantly difference of the patients were divided into the sepsis group and the non sepsis group showing that,there were no significantly difference of the NGAL and Cys-C between the acute kidney injury group and non acute kidney injury group(P>0.05),but there was significantly higher of the acute kidney injury group than the non acute kidney injury group of the NGAL and Cys-C at 24 th hour,48 th hour and 72 th hour(P<0.05).There were much higher of the positive detection rate of the NGAL and Cys-C at 24 th hour,48 th hour and 72 th hour than the ICU immediately in the acute kidney injury group(P<0.05),there was much higher of the positive detection rate of the NGAL and Cys-C at 24 th hour by joint detection than separate detection(P<0.05),but not for the ICU immediately,48 th hour and 72 th hour(P>0.05).Conclusion:There has positive clinical value for the early acute kidney injury diagnosis,condition monitoring and prognostic evaluation of the critically ill patients by the NGAL and Cys-C testing,and it can effectively improve the positive detection rate by the NGAL and Cys-C joint detection,and apply to screening fo the early acute kidney injury.
引文
[1]马晓春,李旭.急性肾损伤定义诊断及其防治进展[J].中国实用内科杂志,2012,32(6):408-411.
[2]付锴,赵久阳,滕思远.急性肾损伤早期生物标志物研究进展[J].大连医科大学学报,2016,38(4):392-396.
[3]张康羿,周姣姣,杨立川,等.AKIN和RIFLE标准评估重症监护病房(ICU)患者急性肾损伤的对比研究[J].临床肾脏病杂志,2012,12(11):494-496.
[4]李裕彬.78例急性肾损伤的诊断及治疗[J].中国医药指南,2013,10(20):221-222.
[5]任玉倩.中性粒细胞明胶酶相关脂质运载蛋白与急性肾损伤[J].中国小儿急救医学,2014,21(10):667-670.
[6]蔡雷鸣,厉倩,金才峰,等.血清中性粒细胞明胶酶相关脂质运载蛋白检测在急性肾功能损伤早期诊断中的临床意义[J].检验医学,2012,27(4):287-290.
[7]徐磊,徐晓萍,应春妹.NGAL在成人心脏术后急性肾损伤中的早期应用价值探讨[J].检验医学,2014,29(2):139-142.
[8]彭兰芬,邓任堂,张少丰,等.NGAL和KIM-1在重症监护室危重患者早期急性肾损伤中的诊断价值[J].检验医学与临床,2013,10(18):2356-2358.
[9]蔡萍.CysC水平变化在早期诊断急性肾损伤中的价值[J].四川医学,2016,37(4):438-440.
[10]韦琪,孔宙,黄育强.血清胱抑素C与血清肌酐在急性肾损伤早期诊断及预后评估价值的临床研究[J].海南医学院学报,2013,19(11):1530-1532,1535.
[11]茹文渊,陈广.血清和尿胱抑素C在不同时期肾综合征出血热急性肾损伤检测中的价值[J].中国医师进修杂志,2013,36(16):52-54.
[2]付锴,赵久阳,滕思远.急性肾损伤早期生物标志物研究进展[J].大连医科大学学报,2016,38(4):392-396.
[3]张康羿,周姣姣,杨立川,等.AKIN和RIFLE标准评估重症监护病房(ICU)患者急性肾损伤的对比研究[J].临床肾脏病杂志,2012,12(11):494-496.
[4]李裕彬.78例急性肾损伤的诊断及治疗[J].中国医药指南,2013,10(20):221-222.
[5]任玉倩.中性粒细胞明胶酶相关脂质运载蛋白与急性肾损伤[J].中国小儿急救医学,2014,21(10):667-670.
[6]蔡雷鸣,厉倩,金才峰,等.血清中性粒细胞明胶酶相关脂质运载蛋白检测在急性肾功能损伤早期诊断中的临床意义[J].检验医学,2012,27(4):287-290.
[7]徐磊,徐晓萍,应春妹.NGAL在成人心脏术后急性肾损伤中的早期应用价值探讨[J].检验医学,2014,29(2):139-142.
[8]彭兰芬,邓任堂,张少丰,等.NGAL和KIM-1在重症监护室危重患者早期急性肾损伤中的诊断价值[J].检验医学与临床,2013,10(18):2356-2358.
[9]蔡萍.CysC水平变化在早期诊断急性肾损伤中的价值[J].四川医学,2016,37(4):438-440.
[10]韦琪,孔宙,黄育强.血清胱抑素C与血清肌酐在急性肾损伤早期诊断及预后评估价值的临床研究[J].海南医学院学报,2013,19(11):1530-1532,1535.
[11]茹文渊,陈广.血清和尿胱抑素C在不同时期肾综合征出血热急性肾损伤检测中的价值[J].中国医师进修杂志,2013,36(16):52-54.