摘要：
Objective To evaluate the neutrophil gelatinase?associated lipocalin(NGAL)and serum cystatin C(Cys C)in the early diagnosis of acute renal dysfunction(AKI)caused by obstruction of ureteral calculi,and it's significance in the assessment of AKI. MethodsRetrospective analysis was performed which involved patients who were in the 174th Hospital of PLA due to u?reteral obstruction from January 2015 to June 2017,from which 32 cases of AKI patients were selected and divided into AKI 1 group 19 cases, AKI 2 group 13 cases. 30 cases in normal renal function were randomly selected as the control group. For all patients, blood NGAL,cystatin C and creatinine and other related examinations were performed within 8 h of admission,and were reviewed again with?in 48 h. If any of the relevant tests suggested acute renal dysfunction,the emergency ureteroscopy and holmium laser lithotripsy and in?dwelling ureteral stents after operative were performed. If renal function was abnormal,elective surgical treatment should be performed, and all patients were re?examined renal function after surgery. Results The levels of Cys C, NGAL and Scr in AKI 2 group were higher than those in AKI 1 group,and the levels of Cys C,NGAL and Scr in AKI 1 group were significantly higher than those in control group(P0.01). The levels of Scr and NGAL in AKI 1 group were significantly lower than those before treatment(P0.01),治疗后AKI 1期组Scr及NGAL水平明显下降(P<0.01),治疗后AKI 2期组Cys C、NGAL及Scr水平明显下降(P<0.01).患者血清NGAL与肌酐水平呈强线性相关(r=0.772,P<0.05),Cys C水平与肌酐呈中等强度相关(r=0.609,P<0.05),ROC曲线分析得知,NGAL的曲线下面积(AUC)为0.981,特异度为93.3%及敏感度为93.8%;Cys C 的 AUC 为0.871,特异度为71.9%,敏感度为93.3%.结论 NGAL 及Cys C作为一种早期诊断指标,能在一定程度上判定AKI的发生及程度,特别是NGAL在AKI诊断上特异性强,是一个敏感的生物学标志物.将NGAL及CysC两者综合分析,对输尿管结石所致的AKI有更好的早期诊断价值.
