尿中性粒细胞明胶酶相关脂质运载蛋白作为急性胰腺炎疾病严重程度和死亡率的早期预测指标

Urinary neutrophil gelatinase-associated lipocalin as an early predictor of disease severity and mortality in acute pancreatitis.

作者信息

Lipinski Michal, Rydzewska-Rosolowska Alicja, Rydzewski Andrzej, Rydzewska Grazyna

机构信息

From the *Department of Gastroenterology, Central Clinical Hospital of the Ministry of Interior, Warsaw; †Department of Nephrology and Transplantation, Medical University of Bialystok, Bialystok; ‡Department of Internal Medicine and Nephrology, Central Clinical Hospital of the Ministry of Interior, Warsaw; and §Faculty of Health Sciences, Uniwersytet Jana Kochanowskiego w Kielcach, Kielce, Poland.

出版信息

Pancreas. 2015 Apr;44(3):448-52. doi: 10.1097/MPA.0000000000000282.

DOI:10.1097/MPA.0000000000000282

PMID:25426620

Abstract

OBJECTIVES

In reference to our earlier publication, laboratory tests that reflect severe intravascular volume depletion can be used for predicting the severity of acute pancreatitis (AP). The aim of the study was to assess whether urinary level of neutrophil gelatinase-associated lipocalin (NGAL) could represent a useful marker of AP severity.

METHODS

We observed a cohort of 104 prospectively enrolled patients. The patients were classified into 3 groups: mild AP, moderately severe AP, and severe AP. Urine samples were collected on admission (NGAL-as) and during the first 24 hours (NGAL-first day) for examination of urinary level of NGAL concentrations from the first day.

RESULTS

Acute pancreatitis was considered severe in 16 (15%) patients, moderately severe in 25 (24%) patients, and mild in 63 (61%) patients.There were statistically significant trends for an increase in severity (P = 0.04, P = 0.003) and mortality (P < 0.031, P = 0.01) with raising NGAL-as and NGAL-first day concentrations, respectively. The areas under the curve for severity predicted by NGAL-as and NGAL-first day were 0.75 and 0.93, respectively. The areas under the curve for mortality prediction by NGAL-as and NGAL-first day were 0.980 and 0.92, respectively.

CONCLUSIONS

The urinary level of NGAL is a promising new diagnostic and prognostic factor for severe AP in an early stage of the disease.

摘要

目的

参考我们早期的出版物，反映严重血管内容量耗竭的实验室检查可用于预测急性胰腺炎（AP）的严重程度。本研究的目的是评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的尿水平是否可作为AP严重程度的有用标志物。

方法

我们观察了一组104例前瞻性入组的患者。患者被分为3组：轻度AP、中度重症AP和重症AP。入院时（NGAL-as）和第1个24小时内（NGAL-第1天）收集尿液样本，以检测第1天的尿NGAL浓度。

结果

16例（15%）患者的急性胰腺炎被认为是重症，25例（24%）患者为中度重症，63例（61%）患者为轻度。随着NGAL-as和NGAL-第1天浓度的升高，严重程度（P = 0.04，P = 0.003）和死亡率（P < 0.031，P = 0.01）分别有统计学意义的升高趋势。NGAL-as和NGAL-第1天预测严重程度的曲线下面积分别为0.75和0.93。NGAL-as和NGAL-第1天预测死亡率的曲线下面积分别为0.980和0.92。