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

摘要

目的探讨尿液、血清中性粒细胞明胶酶转运蛋白（NGAL）和尿肾损伤分子-1（KIM-1）在重症监护室（ICU）危重症患者急性肾损伤（AKI）中的早期诊断价值。方法选取2010年6月至2011年5月本院以各种原发病于ICU病房治疗，且继发AKI的危重症患者23例，同期于ICU治疗的非AKI患者24例和健康者21例，用定量酶联免疫吸附试验（ELISA）检测尿液、血清NGAL和尿KIM-1水平，用常规生化方法检测血清尿素氮（BUN）、肌酐（Cr），用乳胶增强免疫比浊法检测血清胱抑素C（CysC）。健康对照组、AKI患者入院时，AKI患者组、ICU非AKI患者组组间比较采用两独立样本t检验；应用受试者操作特征曲线（ROC曲线）评价各指标对AKI的诊断价值。结果AKI患者组血清NGAL、尿NGAL、尿KIM-1、BUN、Cr和CysC水平显著高于健康对照组，差异有统计学意义（P＜0．01）；AKI患者组与其入院时各研究指标比较，血清NGAL、尿NGAL、尿KIM-1、BUN和Cr水平差异有统计学意义（P＜0．01）；AKI患者组与非AKI患者组间血清NGAL、尿NGAL、尿KIM-1和Cr水平差异有统计学意义（P＜0．01）；血清NGAL、尿液NGAL、尿液KIM-1、Cr、CysC、BUN的ROC曲线下面积依次为1．00、0．97、1．00、0．98、0．98、0．99。结论AKI患者组与其他各研究组间血清NGAL、尿NGAL、尿KIM-1水平差异有统计学意义，血清NGAL、尿NGAL、尿KIM-1作为新的肾损伤标志物，对AKI具有早期诊断价值。%Objective To explore the early diagnostic significance of serum and urine neutrophil gelatinase as-sociated lipocalin (NGAL ) and urine kidney injury molecule-1 (KIM-1) in ICU patients with acute kidney injury (AKI) .Methods A total of 23 AKI patients and 24 non-AKI patients ,hospitalized in ICU of this hospital from Jun . 2010 to May .2011 ,and 21 healthy subjects were enrolled and detected for serum and urine NGAL and KIM-1 ,and serum urea nitrogen (BUN) ,creatinine (Cr) and cystatin C (Cys C) .All data were statistically analyzed .Results Serum levels of NGAL ,BUN ,Cr and Cys C ,and urinary levels of NAGL and KIM in AKI group were higher than healthy group (P<0 .01) .The differences of serum levels of NGAL ,BUN and Cr ,and urinary levels of NGAL and KIM-1 between detection before and after therapy were significant (P<0 .01) .The differences of serum levels of NGAL and Cr ,and urinary levels of NGAL and KIM-1 between AKI group and non-AKI group were significant (P<0 .01) .Area under receiver operating characteristic curve of serum NGAL ,urinary NGAL ,urinary KIM-1 ,serum Cr ,Cys C and BUN was 1 .00 ,0 .97 ,1 .00 ,0 .98 ,0 .98 and 0 .99 respectively .Conclusion The level of serum NGAL ,urine NGAL and KIM-1 could be increased significantly in AKI patients ,which might be with early diagnos-tic value in AKI .