Essajee Farida, Were Fred, Admani Bashir
Aga Khan University Hospital, Nairobi, Kenya.
Pediatr Nephrol. 2015 Jul;30(7):1189-96. doi: 10.1007/s00467-014-3035-9. Epub 2015 Apr 19.
Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term neonates with perinatal asphyxia.
A prospective cohort study was conducted on 108 term babies in the new-born unit of Pumwani Maternity Hospital and Kenyatta National Hospital. Urine NGAL and serum creatinine were measured in 108 term asphyxiated neonates on days 1 and 3 of life.
One-hundred and eight patients were recruited (male:female 1.4:1). At a cut-off of 250 ng/ml, urine NGAL had an acceptable discriminative capability of predicting AKI (area under the curve 0.724). The sensitivity, specificity, positive and negative predictive value and likelihood ratios were 88, 56, 30, 95%, 2 and 0.2 respectively. Urine NGAL levels were significantly higher in patients with AKI compared with those without AKI. An NGAL level greater than 250 ng/ml on day 1 was significantly associated with severe hypoxic ischaemic encephalopathy (HIE); odds ratio = 8.9 (95% CI 1.78-37.69) and mortality; odds ratio = 8.9 (95% CI 1.78-37.69).
Urine NGAL is a good screening test for the early diagnosis of AKI. It is also a predictor of mortality and severity of HIE in asphyxiated neonates.
急性肾损伤（AKI）是围产期窒息最常见的并发症。近期研究表明，尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是AKI的早期标志物；然而，关于其在足月围产期窒息新生儿中的应用数据较少。
在普姆瓦尼妇产医院和肯雅塔国家医院的新生儿病房对108名足月婴儿进行了一项前瞻性队列研究。在出生第1天和第3天对108名足月窒息新生儿测量尿NGAL和血清肌酐。
招募了108名患者（男：女为1.4：1）。在截断值为250 ng/ml时，尿NGAL对预测AKI具有可接受的判别能力（曲线下面积为0.724）。敏感性、特异性、阳性和阴性预测值以及似然比分别为88、56、30、95%、2和0.2。与未发生AKI的患者相比，发生AKI的患者尿NGAL水平显著更高。出生第1天NGAL水平大于250 ng/ml与重度缺氧缺血性脑病（HIE）显著相关；比值比=8.9（95%可信区间1.78 - 37.69），与死亡率也显著相关；比值比=8.9（95%可信区间1.78 - 37.69）。
尿NGAL是早期诊断AKI的良好筛查试验。它也是窒息新生儿死亡率和HIE严重程度的预测指标。
