Objective To investigate the value of serum neutrophil gelatinase-associated lipocalin (sNGAL),urinary neutrophil gelatinase -associated lipocalin (uNGAL),and serun cystatin C (CysC) in the early diagnosis of acute kidney injury (AKI) in patients with liver cirrhosis.Methods A total of 236 patients with liver cirrhosis and normal renal function who visited The Red Cross hospital of Hannan District from January 2015 to March 2017 were enrolled,and according to the presence or absence of AKI within 48 hours after admission,these patients were divided into AKI group with 78 patients and non-AKI group with 158 patients.Another 100 healthy subjects who underwent physical examination were enrolled as control group.ELISA was used to measure sNGAL,uNGAL,and serum CysC,and serum creatinine (SCr) and glomerular filtration rate (GFR) were compared between groups.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the SNK-q test was used tor further comparison between two groups.A Pearson correlation analysis was also performed,and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these indices.Results At 48 hours after admission,there were significant differences in sNGAL,uNGAL,and CysC between the AKI group and the non -AKI group/control group (all P ＜ 0.05).The patients in the AKI group were stratified by AKI stage based on the criteria for kidney injury,and the patients with a higher stage had significantly higher levels of sNGAL and uNGAL than those with a lower stage (both P ＜ 0.05).The levels of sNGAL,uNGAL,and CysC started to increase at 6 hours after admission,while Scr and GFR started to change at 48 hours after admission,i.e.,sNGAL and uNGAL increased significantly earlier than Scr and GFR (P ＜ 0.05).In the AKI group,sNGAL,uNGAL,and CysC were positively correlated with SCr (r =0.650,0.681,and 0.581,all P ＜ 0.05).According to the ROC curve analysis,sNGAL had an area under the ROC curve (AUC) of 0.845 ± 0.435,an optimal cut-off value of 542.68 μg/L,a sensitivity of 0.824,and a specificity of 0.794,uNGAL had an AUC of 0.836-±0.326,an optimal cut-off value of 75.12 μg/L,a sensitivity of 0.816,and a specificity of 0.766,and CysC had an AUC of 0.818 ±0.267,an optimal cut-off value of 1.48 mg/L,a sensitivity of 0.808,and a specificity of 0.732.Conclusion NGAL and CysC can be used as indices for the early diagnosis of AKI and have great significance in evaluating renal injury and developing treatment measures for patients with liver cirrhosis.%目的 检测血、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(CysC)水平,分析其对肝硬化患者并发急性肾损伤(AKI)的早期诊断价值.方法 选择2015年1月-2017年3月于武汉市汉南区红十字会医院就诊的肾功能正常的肝硬化患者236例,依据入院后48 h内是否并发AKI分为AKI组78例,非AKI组158例,选择同期健康体检者100例为对照组.采用ELISA法检测血清NGAL (sNGAL)和尿液NGAL (uNGAL)及血清CysC浓度,并将血肌酐(SCr)浓度和肾小球滤过率(GFR)进行组间比较.计量资料多组间比较采用单因素方差分析,进一步两组间比较采用SNK-q检验;相关分析采用Pearson相关分析法;利用受试者工作特征曲线(ROC曲线)分析相关指标的诊断价值.结果 入院48 h,AKI组sNGAL、uNGAL、CysC同非AKI组和对照组相比,差异均有统计学意义(P值均＜0.05);将AKI组依照肾损伤标准进行分期,分期高的患者sNGAL、uNGAL浓度显著高于分期低的患者,差异均有统计学意义(P值均＜0.05);与入院前比较,入院6h时sNGAL、uNGAL及CysC水平开始升高,而Scr与GFR入院48 h才开始变化,即sNGAL、uNGAL与CysC开始上升时间明显早于Scr与GFR(P值均＜0.05).AKI组患者sNGAL、uNGAL及CysC浓度与SCr呈正相关(r值分别为0.650、0.681、0.581,P值均＜0.05).ROC曲线示,sNGAL曲线下面积为0.845±0.435,最佳阈值为542.68 μg/L,敏感度为0.824,特异度为0.794;uNGAL曲线下面积为0.836±0.326,最佳阈值为75.12 μg/L,敏感度为0.816,特异度为0.766;CysC曲线下面积为0.818±0.267,最佳阈值为1.48 mg/L,敏感度为0.808,特异度为0.732.结论 NGAL与CysC可以作为肝硬化患者发生AKI的早期诊断指标,对了解肝硬化患者的肾功能损伤状况及制订相应措施具有重要意义.
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