Yap Desmond Y H, Seto Wai Kay, Fung James, Chok Siu Ho, Chan See Ching, Chan Gary C W, Yuen Man Fung, Chan Tak Mao
Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
Dig Liver Dis. 2017 Feb;49(2):202-206. doi: 10.1016/j.dld.2016.11.001. Epub 2016 Nov 10.
Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients.
To evaluate use of serum and urine biomarkers to predict HRS.
We prospectively recruited Child's B or C cirrhotic patients with normal serum creatinine, and followed them for 12 weeks for the development of HRS. Serum Cystatin C (CysC), serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL), serum and urine IL-18, serum N-acetyl-β-d glucosaminidase (NAG), urine kidney injury molecule-1 (KIM-1) and urine liver-type fatty acid binding protein (LFABP) were measured at recruitment (baseline), and their relationship with subsequent HRS investigated.
43 patients were included. 12 (27.9%) developed HRS at 7.3±5.1 weeks from baseline. Logistic regression analysis showed that baseline urinary NGAL and urinary KIM-1 were significantly associated with the development of HRS (RR 1.007, 95% CI 1.001-1.012, p=0.014; RR 1.973, 95% CI 1.002-3.886, p=0.049). The cut-off values for NGAL and KIM-1 to predict HRS were 18.72ng/mL and 1.499ng/mL respectively (AUCs 0.84, p=0.005; and 0.78, p=0.008).
Urinary NGAL and KIM-1 could serve as biomarkers to predict HRS in advanced cirrhotic patients.
晚期肝硬化患者肝肾综合征（HRS）的预测仍然困难。
评估血清和尿液生物标志物对HRS的预测作用。
我们前瞻性招募了血清肌酐正常的Child's B级或C级肝硬化患者，并对他们进行了12周的随访，观察HRS的发生情况。在入组时（基线）测量血清胱抑素C（CysC）、血清和尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、血清和尿液白细胞介素-18、血清N-乙酰-β-D-氨基葡萄糖苷酶（NAG）、尿肾损伤分子-1（KIM-1）和尿肝型脂肪酸结合蛋白（LFABP），并研究它们与随后发生的HRS的关系。
纳入43例患者。12例（27.9%）在距基线7.3±5.1周时发生HRS。逻辑回归分析显示，基线时尿NGAL和尿KIM-1与HRS的发生显著相关（相对风险1.007，95%可信区间1.001-1.012，p=0.014；相对风险1.973，95%可信区间1.002-3.886，p=0.049）。预测HRS的NGAL和KIM-1的截断值分别为18.72ng/mL和1.499ng/mL（曲线下面积分别为0.84，p=0.005；和0.78，p=0.008）。
尿NGAL和KIM-1可作为晚期肝硬化患者HRS的预测生物标志物。
