中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤患者连续性肾脏替代治疗的预测价值

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摘要目的探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）对脓毒症合并急性肾损伤（AKI）患者选择连续性肾脏替代治疗（CRRT）的临床预测价值。方法选择 2014年1月～2017年12月上海中医药大学附属第七人民医院急诊重症监护室收治的68例脓毒症且并发AKI的患者。确诊后24 h内收集患者血清NGAL（sNGAL）、尿NGAL（uNGAL）标本，采用酶联免疫吸附测定（ELISA）法进行检测；同时检测血清肌酐（Scr）水平，并进行急性生理与慢性健康评价（APACHEⅡ）评分。根据患者是否需CRRT治疗，分为脓毒症CRRT组（32例）及脓毒症非CRRT组（36例），比较两组sNGAL、uNGAL、Scr水平及APACHEⅡ评分。通过绘制ROC曲线，分别评价sNGAL、uNGAL及两者联合在脓毒症合并AKI早期患者进行CRRT治疗的预测价值。结果两组年龄、性别、发病原因及诊断脓毒症合并AKI当天的Scr水平差异均无统计学意义（P ＞ 0.05）。但脓毒症CRRT组的sNGAL、uNGAL 以及APACHEⅡ评分高于脓毒症非CRRT组（P ＜ 0.05）。ROC曲线分析显示，sNGAL、uNGAL 以及APACHEⅡ评分在预测脓毒症合并AKI患者需CRRT治疗的95%可信区间（95%CI）曲线下面积（AUC）分别为0.863、0.899及0.679。sNGAL联合uNGAL预测价值最高，AUC为0.932。结论在脓毒症合并AKI早期，sNGAL及uNGAL均可作为患者是否需要开展CRRT治疗的预测指标，两者联合的预测价值更高。

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	张莉芬奚希相顼志兵张丽葳▲

关键词 ：中性粒细胞明胶酶相关脂质运载蛋白, 脓毒症, 急性肾损伤, 连续性肾脏替代治疗

Abstract：Objective To explore the clinical predictive value of neutrophil gelatinase-associated lipocalin (NGAL) in selecting continuous renal replacement therapy (CRRT) for septic patients combined with acute kidney injury (AKI). Methods Sixty-eight cases of sepsis patients combined with AKI admitted to Intensive Care Unit of Emergency of the Seventh People′s Hospital of Shanghai University of Traditional Chinese Medicine from January 2014 to December 2017 were selected. Serum NGAL (sNGAL) and urine NGAL (uNGAL) samples were collected within 24 h after diagnosis of AKI, and detected by ehzyme-linked immuno sorbent assay (ELISA) method. Serum creatinine (Scr) level and APACHE Ⅱ score were detected at the same time. According to whether patients needed CRRT treatment, they were divided into sepsis CRRT group (32 cases) and sepsis non CRRT group (36 cases). The differences of sNGAL, uNGAL, Scr and APACHE Ⅱ scores between the two groups were compared. By drawing the ROC curve, the predictive value of sNGAL, uNGAL and their combination in the early stage of sepsis combined with AKI in patients with CRRT was evaluated. Results There were no significant differences in the age, sex, pathogenesis and Scr level between the two groups on the day of sepsis combined with AKI (P > 0.05). However, the scores of sNGAL, uNGAL and APACHE Ⅱ in sepsis CRRT group were higher than those in non CRRT group (P < 0.05). ROC curve analysis showed that sNGAL, uNGAL and APACHE Ⅱ score in predicting sepsis combined with AKI patients needed CRRT treatment (95%CI), the area under the curve (AUC) was 0.863, 0.899 and 0.679, respectively. The prediction value of sNGAL combined with uNGAL was the largest and AUC was 0.932. Conclusion In the early stage of sepsis combined with AKI, sNGAL and uNGAL can be used as predictors of whether patients need CRRT treatment. The predictive value of combination of the two is more valuable.

Key words： Neutrophil gelatinase-associated lipocalin Sepsis Acute kidney injury Continuous renal replacement therapy

基金资助:上海市中医优势病种培育项目（zybz-2017024）。

通讯作者: ▲通讯作者

引用本文:

张莉芬奚希相顼志兵张丽葳▲. 中性粒细胞明胶酶相关脂质运载蛋白对脓毒症合并急性肾损伤患者连续性肾脏替代治疗的预测价值[J]. 中国医药导报, 2018, 15(34): 85-88.
ZHANG Lifen XI Xixiang XU Zhibing ZHANG Liwei▲. Predictive value of neutrophil gelatinase-associated lipocalin for continuous renal replacement therapy in septic patients with acute kidney injury. 中国医药导报, 2018, 15(34): 85-88.

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