Tong Junrong, Li Hong, Zhang Hong, Luo Zhengmao, Huang Yuanhang, Huang Jun, He Feng, Fu Junzhou
*Department of Nephrology, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China; †Department of Comprehensive Evaluation, Medical Association of Guangdong Province, Guangzhou, China; and ‡Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, China.
J Cardiovasc Pharmacol. 2015 Sep;66(3):239-45. doi: 10.1097/FJC.0000000000000268.
The aim of this study was to investigate the predictive value of neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis of contrast-induced nephropathy (CIN).
We searched MEDLINE and Embase until December 2014 for articles evaluating the diagnostic accuracy of plasma/serum and urinary NGAL levels to predict CIN. The primary analysis was based on a hierarchical, bivariate, generalized, linear, mixed model. Diagnostic odds ratio (DOR) and sample size-weighted area under the curve for the receiver operating characteristic (AUROC) were calculated.
Ten studies involving 1310 patients were analyzed. Overall, the DOR/AUROC for NGAL level to predict CIN was 20.56 [95% confidence interval (CI), 9.67-43.74]/0.87 (95% CI, 0.84-0.90), with sensitivity and specificity of 0.80 (95% CI, 0.74-0.85) and 0.83 (95% CI, 0.73-0.90), respectively. Subgroup analysis showed that the diagnostic performance of the DOR/AUROC of urinary NGAL [29.48 (95% CI, 12.19-71.27)/0.87 (95% CI, 0.84-0.90)] was better than that of plasma/serum NGAL [14.63 (95% CI, 4.51-47.38)/0.85 (95% CI, 0.82-0.88)] (DOR, P = 0.005, and AUROC, P = 0.04, respectively).
Plasma/serum and urinary NGAL levels seem to be useful biomarkers in the early prediction of CIN. Moreover, urinary NGAL levels perform better than plasma/serum NGAL.
本研究旨在探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在对比剂肾病（CIN）早期诊断中的预测价值。
检索截至2014年12月的MEDLINE和Embase数据库，查找评估血浆/血清及尿NGAL水平预测CIN诊断准确性的文章。主要分析基于分层、双变量、广义线性混合模型。计算诊断比值比（DOR）及受试者工作特征曲线下样本量加权面积（AUROC）。
分析了涉及1310例患者的10项研究。总体而言，NGAL水平预测CIN的DOR/AUROC为20.56[95%置信区间（CI），9.67 - 43.74]/0.87（95%CI，0.84 - 0.90），敏感性和特异性分别为0.80（95%CI，0.74 - 0.85）和0.83（95%CI，0.73 - 0.90）。亚组分析显示，尿NGAL的DOR/AUROC[29.48（95%CI，12.19 - 71.27）/0.87（95%CI，0.84 - 0.90）]的诊断性能优于血浆/血清NGAL[14.63（95%CI，4.51 - 47.38）/0.85（95%CI，0.82 - 0.88）]（DOR，P = 0.005；AUROC，P = 0.04）。
血浆/血清及尿NGAL水平似乎是CIN早期预测中有价值的生物标志物。此外，尿NGAL水平的表现优于血浆/血清NGAL。
