Section of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Messina, Via Salita Villa Contino, 30, 98100 Messina, Italy.
Curr Vasc Pharmacol. 2013 Nov;11(6):1001-10. doi: 10.2174/157016111106140128124607.
Acute kidney injury (AKI) develops in 10% of patients after surgical abdominal aortic aneurysm (AAA) repair. Neutrophil gelatinase-associated lipocalin (NGAL) is a predictor of AKI and Endothelial Progenitor Cells (EPCs) represent a potential repair mechanism for vascular lesions. We evaluated the diagnostic power of serum (s) and urine (u) NGAL in detecting a possible event of AKI in patients undergoing surgical treatment for AAA repair. We also investigated the influence of vascular injury on EPCs.
We examined 50 patients who underwent open AAA repair. Blood and urine was collected preoperatively and every hour after surgery until 8 h to quantify sNGAL, uNGAL and circulating EPCs. AKI, was defined as a ≥25% decrease in eGFR compared with baseline values.
There was an inverse correlation between eGFR, sNGAL and uNGAL, while a direct correlation between sNGAL APACHE II Score and EPCs was found. At receiver operating characteristic (ROC) analysis, sNGAL and uNGAL showed a very good diagnostic profile. Kaplan Meier curves showed that NGAL is a highly sensitive predictor of incidence of AKI. Univariate followed by multivariate Cox proportional hazard regression analysis showed that uNGAL and sNGAL predicted AKI independently of other potential confounders, including eGFR and APACHE II Score. Patients had at baseline and after surgical stress a significantly higher number of EPCs than control group.
NGAL represents an independent renal predictor of incidence of AKI. EPCs reflect the degree of vascular damage and could be considered as an indicator of disease with a reparative-regenerative vascular-endothelial function.
10%接受手术治疗的腹主动脉瘤（AAA）修复患者会发生急性肾损伤（AKI）。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是 AKI 的预测因子，而内皮祖细胞（EPCs）代表了血管病变的潜在修复机制。我们评估了血清（s）和尿液（u）NGAL 在检测接受手术治疗的 AAA 修复患者发生 AKI 事件的诊断能力。我们还研究了血管损伤对 EPCs 的影响。
我们检查了 50 名接受开放 AAA 修复的患者。在术前和术后每小时收集血液和尿液，直到 8 小时，以定量检测 sNGAL、uNGAL 和循环 EPCs。AKI 的定义为与基线值相比 eGFR 下降≥25%。
eGFR、sNGAL 和 uNGAL 之间存在反比关系，而 sNGAL APACHE II 评分与 EPCs 之间存在直接关系。在接受者操作特征（ROC）分析中，sNGAL 和 uNGAL 表现出非常好的诊断特征。Kaplan-Meier 曲线显示，NGAL 是 AKI 发生率的高度敏感预测因子。单因素和多因素 Cox 比例风险回归分析表明，uNGAL 和 sNGAL 独立于其他潜在混杂因素，包括 eGFR 和 APACHE II 评分，预测 AKI。与对照组相比，患者在基线和手术应激后具有明显更高数量的 EPCs。
NGAL 是 AKI 发生率的独立肾脏预测因子。EPCs 反映了血管损伤的程度，可被视为具有修复-再生血管内皮功能的疾病指标。
