Shen Shui-juan, Hu Zuo-xiang, Li Qing-hua, Wang Shi-min, Song Chun-jiao, Wu Dong-dong, He Jian-ling, Guan Ji-chao, Shan Juan-ping
Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China.
Nephrology (Carlton). 2014 Mar;19(3):129-35. doi: 10.1111/nep.12203.
Early intervention in patients with chronic kidney disease (CKD) significantly improves the prognosis. The present widely used markers of renal function, such as serum creatinine (sCr), fail to reflect early renal damage and predict the progression of disease. The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD.
We identified 92 patients with stage 2-4 CKD caused by primary chronic glomerulonephritis. The patients were followed for 2 years, the changes in NGAL levels in the progressive and non-progressive groups were compared.
First, the serum NGAL levels of patients with stage 2-4 CKD were significantly increased compared with the control group. Second, based on Pearson correlation analysis, positive correlations existed between NGAL and cystatin C levels and between NGAL and sCr levels. Third, bounded by the progress of renal function, the area under the curve of serum NGAL was 0.872 (95% confidence interval, 0.786-0.933), which suggests a blood NGAL cut-off level of 246 ng/mL (sensitivity 85.19%, specificity 81.54%). Fourth, Kaplan-Meier survival curve analysis showed that the serum NGAL level was closely related to the end-point of renal function in patients with CKD. Fifth, Cox multivariate regression analysis showed that the estimated glomerular filtration rate and blood NGAL are associated with progression of CKD.
Serum NGAL is an effective biomarker for detecting early-stage renal damage in CKD patients. Serum NGAL was significantly correlated with the severity of renal damage and the progression of renal function deterioration.
对慢性肾脏病（CKD）患者进行早期干预可显著改善预后。目前广泛使用的肾功能标志物，如血清肌酐（sCr），无法反映早期肾损伤情况，也无法预测疾病进展。作者旨在评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）这一新型急性肾损伤特异性生物标志物是否可预测CKD的进展。
我们纳入了92例由原发性慢性肾小球肾炎导致的2-4期CKD患者。对这些患者进行了2年的随访，比较了病情进展组和非进展组中NGAL水平的变化。
首先，与对照组相比，2-4期CKD患者的血清NGAL水平显著升高。其次，基于Pearson相关性分析，NGAL与胱抑素C水平之间以及NGAL与sCr水平之间均存在正相关。第三，以肾功能进展为界值，血清NGAL的曲线下面积为0.872（95%置信区间，0.786-0.933），这表明血液NGAL的截断水平为246 ng/mL（敏感性85.19%，特异性81.54%）。第四，Kaplan-Meier生存曲线分析显示，血清NGAL水平与CKD患者的肾功能终点密切相关。第五，Cox多因素回归分析显示，估计肾小球滤过率和血液NGAL与CKD的进展相关。
血清NGAL是检测CKD患者早期肾损伤的有效生物标志物。血清NGAL与肾损伤严重程度及肾功能恶化进展显著相关。
