Park Ga-Young, Yu Chung-Hoon, Kim Jun-Seop, Kang Yun-Jeong, Kwon Owen, Choi Ji-Young, Cho Jang-Hee, Kim Chan-Duck, Kim Yong-Lim, Park Sun-Hee
Department of Internal Medicine, Kyungpook National University School of Medicine and Clinical Research Center for End Stage Renal Disease, Daegu, Korea.
Korean J Intern Med. 2015 May;30(3):345-53. doi: 10.3904/kjim.2015.30.3.345. Epub 2015 Apr 29.
BACKGROUND/AIMS: Neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. We evaluated the value of plasma NGAL (pNGAL) as an independent predictor of prognosis in immunoglobulin A nephropathy (IgAN).
In total, 91 patients with biopsy-proven IgAN at a single center were evaluated. pNGAL was measured using a commercial enzyme-linked immunosorbent assay kit (R&D Systems). Adverse renal outcome was defined as chronic kidney disease (CKD) stage 3 or above at the last follow-up. Pearson correlation coefficient and Cox regression were used for analyses.
The mean age of all patients (male:female, 48:43) was 35 years (range, 18 to 77). pNGAL ranged between 21.68 and 446.40 ng/mL (median, 123.97) and showed a correlation with age (r = 0.332, p = 0.001), creatinine (r = 0.336, p = 0.001), estimated glomerular filtration rate (r = -0.397, p < 0.001), uric acid (r = 0.289, p = 0.006), and the protein-to-creatinine ratio (r = 0.288, p = 0.006). During a mean follow-up period of 37.6 months, 11 patients (12.1%) had CKD stage 3 or above. In a multivariate Cox regression model, hypertension (hazard ratio [HR], 8.779; 95% confidence interval [CI], 1.526 to 50.496; p = 0.015), proteinuria > 1 g/day (HR, 5.184; 95% CI, 1.124 to 23.921; p = 0.035), and pNGAL (HR, 1.012; 95% CI, 1.003 to 1.022; p = 0.013) were independent predictors associated with adverse renal outcome.
pNGAL showed strong correlations with other clinical prognostic factors and was also an independent predictor of adverse renal outcome. We suggest pNGAL as a potential predictor for prognosis in IgAN, while further studies are needed to confirm the clinical value.
背景/目的：中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是急性肾损伤的一种知名生物标志物。我们评估了血浆NGAL（pNGAL）作为免疫球蛋白A肾病（IgAN）预后独立预测指标的价值。
对单个中心91例经活检证实为IgAN的患者进行评估。使用商用酶联免疫吸附测定试剂盒（R&D Systems）检测pNGAL。不良肾脏结局定义为末次随访时慢性肾脏病（CKD）3期及以上。采用Pearson相关系数和Cox回归进行分析。
所有患者（男:女，48:43）的平均年龄为35岁（范围18至77岁）。pNGAL范围在21.68至446.40 ng/mL之间（中位数为123.97），且与年龄（r = 0.332，p = 0.001）、肌酐（r = 0.336，p = 0.001）、估计肾小球滤过率（r = -0.397，p < 0.001）、尿酸（r = 0.289，p = 0.006）及蛋白肌酐比（r = 0.288，p = 0.006）相关。在平均37.6个月的随访期内，11例患者（12.1%）达到CKD 3期及以上。在多变量Cox回归模型中，高血压（风险比[HR]，8.779；95%置信区间[CI]，1.526至50.496；p = 0.015）、蛋白尿>1 g/天（HR，5.184；95% CI，1.124至23.921；p = 0.035）及pNGAL（HR，1.012；95% CI，1.003至1.022；p = 0.013）是与不良肾脏结局相关的独立预测指标。
pNGAL与其他临床预后因素密切相关，也是不良肾脏结局的独立预测指标。我们建议将pNGAL作为IgAN预后的潜在预测指标，不过还需要进一步研究来证实其临床价值。
