血清中性粒细胞明胶酶相关脂质运载蛋白水平与卒中发生及患者肾功能损害的关系

摘要

目的 探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与脑卒中发生及患者肾功能损害的关系.方法 随机选择首诊出血性卒中(HS)患者63例、缺血性卒中(IS)患者233例以及门诊健康受试者293例,记录其年龄、性别以及高血压、糖尿病、冠心病和高尿酸血症病史,并于入院次日或体检时检测其血清肾脏标志物(NGAL,Cr,Urea,Cys C和eGFR)水平,按照KDIGO指南标准将所有受试者分为AKI组、CKD组、一过性或无肾损害组以及对照组,代表其肾功能损害程度,分析上述各指标与HS和IS患者卒中发生及其肾功能损害的关系.结果 HS和IS患者NGAL血清水平中值为160.0 μg/L和142.9 μg/L,其差异无统计学意义(Z=2.332,P＞0.05),但均高于健康对照(Z=12.621,9.189,均P＜0.05);AKI组、CKD组、一过性或无肾损害组和对照组NGAL血清水平中值分别为375.3,228.6,141.6和103.8 μg/L,相互之间差异均有统计学意义(Z=3.661～11.237,均P＜0.05).NGAL血清水平与HS发生(rp=0.423,P＜0.001)、IS发生(rp=0.231,P＜0.001)及HS和IS患者肾功能损害(rp=0.429,0.289,均P＜0.001)均呈正相关,其偏相关系数在HS发生中仅低于高血压病史率,在IS发生中仅低于冠心病和糖尿病病史率,但在HS和IS患者肾功能损害中均最高.NGAL以其血清水平评估HS和IS发生,作用有限(OR=1.044和1.028,均P＜0.001),但以异常检出来评估则作用明显(OR=27.841和15.411,均P＜0.001).结论 NGAL水平增高可能是卒中发生的危险因素,提示肾损伤或肾功能不全可能与卒中发生相关,卒中防治宜重视患者NGAL的改变.%Objective To explore the correlations of neutrophil gelatinase associated lipocalin (NGAL) with cerebral stroke attack and renal dysfunction of patients.Methods 63 patients with first-diagnosed hemorrhagic stroke (HS),233 patients with first diagnosed ischemic stroke (IS) and 293 healthy controls were randomly selected.Their age,gender and clinical his tory of hypertension,diabetes,coronary heart disease and hyperuricemia were recorded at admission,and their serum levels of kidney function/injury biomarkers (NGAL,Cr,Urea,CysC and eGFR) were measured at the next day.According to KDIGO guidelines standards,all subjects were divided into four groups on behalf of their renal damage degree:AKI,CKD,transient or no kidney injury,and control group.And then,the relations of these indicators with stroke attack and renal function of HS and IS patients were analyzed.Results The medians of serum NGAL levels in the patients with HS and IS were 160.0 and 142.9 μg/L,their difference had no statistical significance (Z=2.332,P＞0.05),but were higher than healthy controls (Z =12.621,9.189,all P＜0.05).The levels of serum NGAL in AKI,CKD,transient or no renal dysfunction,and control groups were 375.3,228.6,141.6 and 103.8 μg/L respectively,which had statistically significant differences between each other (Z=3.661～11.237,all P＜0.05).NGAL level was positively related to HS attack (rp=0.423,P＜0.001),IS attack (rp =0.231,P＜0.001) and renal dysfunction in both HS and IS patients (rp=0.429,0.289,all P＜0.001).Its partial cor relation coefficient was only lower than hypertension within HS stroke attack,and lower than coronary heart disease and diabetes within IS stroke attack,but the highest within renal function of either HS or IS patients.For assessing HS and IS attack,NGAL levels play a limited role (OR=1.044,0.974,allP＜0.001),in contrary to NGAL abnormity (OR =27.841,15.411,all P＜0.001).Conclusion Elevated NGAL levels may be a risk factor for stroke,suggesting that kidney injury or renal dysfunction may be associated with stroke,and the prevention and treatment of stroke should pay attention to the change of NGAL.