尿NGAL联合尿沉渣评分在预测糖尿病肾病并发急性肾损伤预后中的临床价值
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摘要
目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)及尿沉渣在预测糖尿病肾病(diabetic kidney disease,DKD)并发急性肾损伤(acute kidney injury,AKI)预后中的临床价值。方法选取DKD并发AKI患者60例,根据病因分为肾前性AKI和肾小管坏死(acute tubular necrosis,ATN)2组,根据肾脏预后分为肾脏存活和肾脏丢失2组,分别比较2种分组组间的尿NGAL及尿沉渣评分。运用受试者工作特征曲线(receiver operator characteristic curve,ROC)下面积(area under curve,AUC)评价尿NGAL及尿沉渣评分预测患者肾脏丢失的敏感性与特异性。结果肾前性AKI 34例,ATN 26例,前者的尿NGAL及尿沉渣评分均低于后者(P<0.01);肾脏存活39例,肾脏丢失21例,前者的尿NGAL及尿沉渣评分均低于后者(P<0.01)。以AUC>0.9为标准,ROC曲线显示NGAL和尿沉渣评分对DKD并发AKI患者肾脏预后的预测价值和准确性均较高。结论尿NGAL联合尿沉渣评分可以很好地预测DKD并发AKI患者的肾脏预后。
Objective To investigate the clinical value of urinary neutrophil gelatinase associated lipocalin( NGAL) and urinary sediment score in predicting kidney prognosis of the patients of acute kidney injury( AKI) on the basis of diabetic kidney disease( DKD). Methods A total of 60 hospitalized patients with AKl on DKD were enrolled,who were divided into prorenal AKI group and renal tubular necrosis( ATN) group according to cause of AKI,and were also divided into kidney survival group and kidney loss group according to kidney prognosis. Urinary NGAL levels and urinary sediment scores between prorenal AKI group and ATN group,and between kidney survival group and loss group,were compared respectively. Area under curve( AUC) of receiver operating characteristic( ROC) curve of urinary NGAL and sediment score were used to evaluate the sensitivity and specificity in predicting kidney loss. Results The urinary NGAL levels and the urinary sediment scores of 34 prorenal AKI patients were both lower than those of 26 ATN patients( P < 0. 01). The urinary NGAL levels and the urinary sediment scores of39 kidney survival patients were both lower than those of 21 kidney loss patients( P < 0. 01). By the standard of AUC > 0. 9,the ROC curve showed urinary NGAL and sediment score had high predictive value and high accuracy in the kidney prognosis of AKI on DKD patients. Conclusion The NGAL and urinary sediment score may predict kidney prognosis of patients with AKI on DKD.
Objective To investigate the clinical value of urinary neutrophil gelatinase associated lipocalin( NGAL) and urinary sediment score in predicting kidney prognosis of the patients of acute kidney injury( AKI) on the basis of diabetic kidney disease( DKD). Methods A total of 60 hospitalized patients with AKl on DKD were enrolled,who were divided into prorenal AKI group and renal tubular necrosis( ATN) group according to cause of AKI,and were also divided into kidney survival group and kidney loss group according to kidney prognosis. Urinary NGAL levels and urinary sediment scores between prorenal AKI group and ATN group,and between kidney survival group and loss group,were compared respectively. Area under curve( AUC) of receiver operating characteristic( ROC) curve of urinary NGAL and sediment score were used to evaluate the sensitivity and specificity in predicting kidney loss. Results The urinary NGAL levels and the urinary sediment scores of 34 prorenal AKI patients were both lower than those of 26 ATN patients( P < 0. 01). The urinary NGAL levels and the urinary sediment scores of39 kidney survival patients were both lower than those of 21 kidney loss patients( P < 0. 01). By the standard of AUC > 0. 9,the ROC curve showed urinary NGAL and sediment score had high predictive value and high accuracy in the kidney prognosis of AKI on DKD patients. Conclusion The NGAL and urinary sediment score may predict kidney prognosis of patients with AKI on DKD.
引文
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[6]刘亚红,苑丽华.尿沉渣联合尿KIM-1、NGAL在诊断原发性肾脏病合并急性肾小管间质病变中的意义[J].国际泌尿系统杂志,2015,35(2):176-179.
[7]刘进,杨满,梅丽凡.尿中性粒细胞明胶酶相关脂质运载蛋白对急性肾损伤的诊断价值[J].重庆医学,2015,44(13):1735-1737.
[8]Kanbay M,Kasapoglu B,Perazella MA.Acute tubular necrosis and pre-renal acute kidney injury:utility of urine microscopy in their evaluation-a systematic review[J].Int Urol Nephrol,2010,42(2):425-433.
[9]Perezella MA,Coca SG,Hall IE,et al.Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients[J].Clin J Am Soc Nephrol,2010,5(3):402-408.
[10]陈昕,刘琦,刘进.急性肾损伤患者尿沉渣评分与肾损伤严重程度的关系[J].中华临床医师杂志:电子版,2015,9(5):767-770.
[11]李惊子,王素霞,秦小琪,等.尿沉渣与肾脏病理类型的相关性[J].北京大学学报:医学版,2014,46(6):920-925.
[12]李惊子,王素霞,秦小琪,等.Ig A肾病尿沉渣谱与肾脏病理改变的相关关系[J].中华肾脏病杂志,2015,31(2):91-96.
[13]Kidney Disease Improving Global Outcomes(KDIGO)Acute Kidney Injury Work Group.KDIGO clinical practice guideline for acute kidney injury[J].Nephron Clin Pract,2012,120:c179-c184.
[14]陆任,华方燕,高嘉元,等.住院患者急性肾损伤的发病及预后相关危险因素分析[J].中华肾脏病杂志,2012,28(3):194-200.
[15]张念荣,卓莉,李文歌.不同肾脏病理糖尿病肾病之临床表现分析[J].国际泌尿系统杂志,2015,35(5):722-725.
[16]Fogazzi GB,Garigali G,Pirovano B,et al.How to improve the teaching of urine microscopy[J].Clin Chem Lab Med,2007,45(3):407-412.
[17]Devarajan P.Neutrophil gelatinase-associated lipocalin:a promising biomarker for human acute kidney injury[J].Biomark Med,2012,4(2):265-280.
[18]刘亚红,朱雅,高倩,等.尿沉渣动态变化在慢性肾小球疾病基础上急性肾小管间质损伤中的应用[J].国际泌尿系统杂志,2018,38(1):122-126.
[19]陆任华,严玉澄,车妙琳,等.肾科医生会诊时的生物学标志物水平对预测急性肾损伤患者预后的价值[J].中华肾脏病杂志,2013,29(3):163-168.
[2]James MT,Hemmelgarn BR,Wiebe N,et al.Glomernlar filtration rate,proteinuria,and the incidence and consequences of acute kidney injury:a cohort study[J].Lancet,2010,376(9758):2096-2103.
[3]刘亚红,武亮.慢性肾脏病并发急性肾损伤和无慢性肾脏病基础急性肾损伤的预后比较分析[J].临床内科杂志,2014,31(8):540-542.
[4]Che M,Xie B,Xue S,et al.Clinical usefulness of novel biomarkers for the detection of acute kidney injury following e Iective cardiac surgery[J].Nephron Clin Pract,2010,115(1):c66-c72.
[5]Ling W,Zhaohui N,Ben H,et al.Urinarry IL-18 and NGAL as early predictive biomarkers in contrast-induced nephropathy after coronary angiogrophy[J].Nephron Clin Pract,2008,108(3):c176-c181.
[6]刘亚红,苑丽华.尿沉渣联合尿KIM-1、NGAL在诊断原发性肾脏病合并急性肾小管间质病变中的意义[J].国际泌尿系统杂志,2015,35(2):176-179.
[7]刘进,杨满,梅丽凡.尿中性粒细胞明胶酶相关脂质运载蛋白对急性肾损伤的诊断价值[J].重庆医学,2015,44(13):1735-1737.
[8]Kanbay M,Kasapoglu B,Perazella MA.Acute tubular necrosis and pre-renal acute kidney injury:utility of urine microscopy in their evaluation-a systematic review[J].Int Urol Nephrol,2010,42(2):425-433.
[9]Perezella MA,Coca SG,Hall IE,et al.Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients[J].Clin J Am Soc Nephrol,2010,5(3):402-408.
[10]陈昕,刘琦,刘进.急性肾损伤患者尿沉渣评分与肾损伤严重程度的关系[J].中华临床医师杂志:电子版,2015,9(5):767-770.
[11]李惊子,王素霞,秦小琪,等.尿沉渣与肾脏病理类型的相关性[J].北京大学学报:医学版,2014,46(6):920-925.
[12]李惊子,王素霞,秦小琪,等.Ig A肾病尿沉渣谱与肾脏病理改变的相关关系[J].中华肾脏病杂志,2015,31(2):91-96.
[13]Kidney Disease Improving Global Outcomes(KDIGO)Acute Kidney Injury Work Group.KDIGO clinical practice guideline for acute kidney injury[J].Nephron Clin Pract,2012,120:c179-c184.
[14]陆任,华方燕,高嘉元,等.住院患者急性肾损伤的发病及预后相关危险因素分析[J].中华肾脏病杂志,2012,28(3):194-200.
[15]张念荣,卓莉,李文歌.不同肾脏病理糖尿病肾病之临床表现分析[J].国际泌尿系统杂志,2015,35(5):722-725.
[16]Fogazzi GB,Garigali G,Pirovano B,et al.How to improve the teaching of urine microscopy[J].Clin Chem Lab Med,2007,45(3):407-412.
[17]Devarajan P.Neutrophil gelatinase-associated lipocalin:a promising biomarker for human acute kidney injury[J].Biomark Med,2012,4(2):265-280.
[18]刘亚红,朱雅,高倩,等.尿沉渣动态变化在慢性肾小球疾病基础上急性肾小管间质损伤中的应用[J].国际泌尿系统杂志,2018,38(1):122-126.
[19]陆任华,严玉澄,车妙琳,等.肾科医生会诊时的生物学标志物水平对预测急性肾损伤患者预后的价值[J].中华肾脏病杂志,2013,29(3):163-168.