[血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）可预测脓毒性休克患者入住重症监护病房时的急性肾损伤]

[Plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) predicts acute kidney injury in septic shock at ICU admission].

作者信息

Camou F, Oger S, Paroissin C, Guilhon E, Guisset O, Mourissoux G, Pouyes H, Lalanne T, Gabinski C

机构信息

Service de réanimation médicale, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux, France.

出版信息

Ann Fr Anesth Reanim. 2013 Mar;32(3):157-64. doi: 10.1016/j.annfar.2012.11.012. Epub 2013 Feb 28.

DOI:10.1016/j.annfar.2012.11.012

PMID:23453486

Abstract

PURPOSE

To validate plasma Neutrophil Gelatinase-Associated Lipocalin (pNGAL) as an early biomarker in intensive care unit (ICU) for acute kidney injury (AKI) in critically ill adult with septic shock.

PATIENTS AND METHOD

Fifty consecutive patients with septic shock were included in this observational cohort study. AKI was defined if patients met any RIFLE or AKIN criteria. The main objective was to evaluate diagnosis value of pNGAL measured with a point-of-care device at admission (D0), at 24hours (D1) and at 48hours (D2).

RESULTS

Among the 50 patients enrolled, 86% had AKI, 48% had persistent renal AKI and 30% required renal replacement therapy (RRT) during their ICU stay. At D0, pNGAL concentration was significantly higher in patients with AKI compared to patients without AKI (471ng/mL versus 134ng/mL, P<0.001). This level remained significantly higher in the AKI population at D1 and D2 and pNGAL concentration at D0 among AKI patients increased with kidney failure level. At D1, pNGAL was significantly higher for persistent renal AKI rather than transient prerenal (570ng/mL versus 337ng/mL, P=0.027). pNGAL concentration below 348ng/mL at D1 was never seen in patients with RRT.

CONCLUSION

Plasma NGAL is a useful, sensitive and early biomarker to predict persistent AKI in septic shock at ICU admission and help to discuss RRT.

摘要

目的

验证血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）作为重症监护病房（ICU）中重症感染性休克成年患者急性肾损伤（AKI）的早期生物标志物。

患者与方法

本观察性队列研究纳入了50例连续的感染性休克患者。如果患者符合任何RIFLE或AKIN标准，则定义为AKI。主要目的是评估在入院时（D0）、24小时（D1）和48小时（D2）使用即时检测设备测量的pNGAL的诊断价值。

结果

在纳入的50例患者中，86%发生了AKI，48%发生了持续性肾AKI，30%在ICU住院期间需要肾脏替代治疗（RRT）。在D0时，AKI患者的pNGAL浓度显著高于无AKI患者（471ng/mL对134ng/mL，P<0.001）。在D1和D2时，AKI人群中的这一水平仍显著更高，且AKI患者在D0时的pNGAL浓度随肾衰竭程度增加。在D1时，持续性肾AKI患者的pNGAL显著高于短暂性肾前性患者（570ng/mL对337ng/mL，P=0.027）。接受RRT的患者在D1时从未出现过低于348ng/mL的pNGAL浓度。