中性粒细胞明胶酶相关脂质运载蛋白是肝移植受者肾功能及损伤的理想标志物吗？
Is neutrophil gelatinase-associated lipocalin an optimal marker of renal function and injury in liver transplant recipients?
作者信息
Hryniewiecka E, Gala K, Krawczyk M, Pączek L
机构信息
Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
出版信息
Transplant Proc. 2014 Oct;46(8):2782-5. doi: 10.1016/j.transproceed.2014.09.013.
BACKGROUND
Recently, research has focused on the association of neutrophil gelatinase-associated lipocalin (NGAL) with acute and/or active kidney injury. However, it should be remembered that NGAL is involved in iron metabolism and antimicrobial defense mechanisms.
METHODS
One hundred seven consecutive liver transplant recipients were included in this study. Plasma and urine NGAL levels were measured with the use of enzyme-linked immunosorbent assay. NGAL levels were studied as plasma concentrations (pNGAL), urine concentrations (uNGAL), urinary NGAL to creatinine ratio (uNGAL/Cr), and fractional NGAL secretion (fNGAL).
RESULTS
pNGAL was found to be inversely correlated with estimated glomerular filtration rate (eGFR) and plasma cystatine C (pCysC) (r = -0.26 and P = .007, r = -0.38 and P = .00006, respectively). uNGAL was positively correlated with urinary cystatine C to creatinine ratio (uCysC/Cr) and fractional cystatine C excretion (fCysC) (r = 0.43 and P = .000004; r = 0.4 and P = .1; respectively). uNGAL/Cr was inversely correlated with hematocrit (Htc) and hemoglobin (Hb) (r = -0.35 and P = .0002; r = -0.39 and P = .00004; respectively), and positively correlated with uCysC/Cr (r = 0.5 and P < .0000001). fNGAL was directly correlated with uCysC/Cr and fCysC (r = 0.53 and P < .0000001; r = 0.39 and P = .00005; respectively) and inversely correlated with red blood cell count (RBC; r = -0.31 and P = .001). We observed significant differences of pNGAL, uNGAL/Cr, and fNGAL between sexes, with highest values of uNGAL, uNGAL/Cr, and fNGAL in women and pNGAL in men. In multivariate regression analysis, pNGAL was positively correlated with time elapsed from liver transplantation, neutrophil count, pCysC, and sex (β = 0.36 and P = .00001; β = 0.32 and P = .0001; β = 0.58 and P < .0000001; β = 0.17 and P = .025; respectively) and inversely correlated with patient's age (β = -0.18 and P = .02) with R = 0.67 and R(2) = 0.45, independently from blood glucose, eGFR, RBC, white blood cell count, Hb, uCysC, uCysC/Cr, and fCysC.
CONCLUSIONS
Plasma and urine NGAL levels are strongly correlated not only with kidney function parameters, but also with red and white blood cell parameters and patient's age and sex.
背景
最近，研究聚焦于中性粒细胞明胶酶相关脂质运载蛋白（NGAL）与急性和/或活动性肾损伤的关联。然而，应记住NGAL参与铁代谢和抗菌防御机制。
方法
本研究纳入了107例连续的肝移植受者。采用酶联免疫吸附测定法测量血浆和尿液中的NGAL水平。NGAL水平以血浆浓度（pNGAL）、尿液浓度（uNGAL）、尿NGAL与肌酐比值（uNGAL/Cr）和NGAL分数分泌（fNGAL）进行研究。
结果
发现pNGAL与估计肾小球滤过率（eGFR）和血浆胱抑素C（pCysC）呈负相关（r分别为-0.26和P = 0.007，-0.38和P = 0.00006）。uNGAL与尿胱抑素C与肌酐比值（uCysC/Cr）和胱抑素C分数排泄（fCysC）呈正相关（r分别为0.43和P = 0.000004；0.4和P = 0.1）。uNGAL/Cr与血细胞比容（Htc）和血红蛋白（Hb）呈负相关（r分别为-0.35和P = 0.0002；-0.39和P = 0.00004），与uCysC/Cr呈正相关（r = 0.5且P < 0.0000001）。fNGAL与uCysC/Cr和fCysC呈正相关（r分别为0.53和P < 0.0000001；0.39和P = 0.00005），与红细胞计数（RBC；r = -0.31且P = 0.001）呈负相关。我们观察到pNGAL、uNGAL/Cr和fNGAL在性别之间存在显著差异，女性的uNGAL、uNGAL/Cr和fNGAL值最高，男性的pNGAL值最高。在多变量回归分析中，pNGAL与肝移植后的时间、中性粒细胞计数、pCysC和性别呈正相关（β分别为0.36和P = 0.00001；0.32和P = 0.0001；0.58和P < 0.0000001；0.17和P = 0.025），与患者年龄呈负相关（β = -0.18且P = 0.02），R = 0.67且R² = 0.45，独立于血糖、eGFR、RBC、白细胞计数、Hb、uCysC、uCysC/Cr和fCysC。
结论
血浆和尿液NGAL水平不仅与肾功能参数密切相关，还与红细胞和白细胞参数以及患者年龄和性别密切相关。
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