NGAL在成人心脏术后急性肾损伤中的早期应用价值探讨

摘要

目的：探讨血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在成人心脏术后急性肾损伤（AKI）早期诊断中的应用价值。方法收集成人心脏手术患者62例，分别在其术前及术后6、24、48 h采集血液标本。采用酶法检测血清肌酐（SCr），并以48 h内 SCr上升至≥26．5μmol/L作为AKI的诊断标准，其中23例发生AKI （AKI组）、39例未发生AKI（无AKI组）。应用乳胶增强免疫透射比浊法分别检测2组患者的血清NGAL和半胱氨酸蛋白酶抑制剂C（Cys C）水平。结果与术前比较，AKI组术后6、24、48 h血清NGAL水平均明显上升（P＜0．01）；血清Cys C水平在术后24、48 h明显上升（P＜0．01）。无AKI组术后6、24、48 h血清NGAL水平差异均无统计学意义（P＞0．05）；血清Cys C水平术后6、24 h差异无统计学意义（P＞0．05），术后48 h升高（P＜0．05）。结论血清NGAL水平在成人心脏术后发生AKI 6 h即明显上升，明显早于Cys C和SCr。血清NGAL可以作为早期诊断成人心脏术后AKI的标志物。%Objective To investigate the early diagnosis significance of neutrophil gelatinase-associated lipocalin (NGAL)on acute kidney injury (AKI)in patients undergoing cardiac surgery.Methods Blood samples before and after surgery were collected from 62 patients undergoing cardiac surgery.The blood samples were collected before surgery and at 6,24 and 48 h after surgery respectively.The serum creatinine (SCr)was detected by enzymatic method.AKI was defined as diagnosis standard at SCr≥26.5 μmol/L within 48 h.There were 23 AKI patients (AKI group)and 39 patients without AKI (non AKI group).Serum NGAL and serum cystatin C(Cys C)were detected by latex-enhanced immunoturbidimetry.Results Serum NGAL increased significantly at 6,24,48 h after surgery(P<0.01 ),while serum Cys C increased at 24 and 48 h after surgery in AKI group (P<0.01 ).There was no statistical significance for NGAL in non AKI group before and at 6,24 and 48 h after surgery(P>0.05).There was no statistical significance for CysC in non AKI group before and at 6 and 24 h after surgery(P>0.05 ).However,Cys C in non AKI group at 48 h after surgery increased (P<0.05 ).Conclusions Serum NGAL at 6 h after cardiac surgery are predictive for AKI, which is much earlier than Cys C and SCr.Serum NGAL can be used as early markers for AKI after cardiac surgery.