Shalenkova M A, Mikhailova Z D, Klimkin P F
State Budgetary Institution of Health Care of the Nizhny Novgorod Region, "Municipal Clinical Hospital #38".
Kardiologiia. 2018(S3):19-26.
To study the role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker for extrarenal complications in patients with acute coronary syndrome (ACS).
For 110 patients with ACS on days 1-3 of hospitalization, concentrations of NGAL, serum (s-NGAL) and urinary (u-NGAL) NGAL, and N-terminal fragment of pro-B natriuretic peptide (NT-proBNP) were measured, and transthoracic echocardiography was performed. Incidence of cardiovascular complications was determined during the stay in the hospital; hemodynamic parameters (systolic and diastolic blood pressure, heart rate) were measured on admission.
Concentrations of u-NGAL were significantly higher in acute heart failure (AHF) [10.4 (2.7; 51.2) ng/ml] than in absence of AHF [3.8 (1.7; 8.6) ng/ml, р=0.03]. Concentrations of u-NGAL and NT-proBNP were higher in patients with [10.17 (4.87; 51.2 ng/ml) and 744.6 (368.7; 2034.9) pg/ml] than without signs of pulmonary hypertension [3.41 (1.72; 7.39) ng/ml; р=0.004 and 431.8 (99.6; 780.1) pg/ml; р=0.012]. The u-NGAL values >9.96 ng / ml were shown to be predictive for AHF, and values >5.81 ng/ml - for pulmonary hypertension. Levels of u-NGAL significantly, directly correlated with values of end-diastolic dimensions and end-systolic dimensions and inversely correlated with values of end-diastolic volume and ejection fraction; levels of s-NGAL positively correlated with cardiac output and heart index. Levels of u-NGAL significantly, directly correlated with NT-proBNP values.
Urinary levels of NGAL were significantly higher in ACS patients with than without AHF or signs of pulmonary hypertension. NGAL values >9.96 ng/ml were associated with an increased probability of AHF during stay in the hospital, and NGAL values >5.81 ng/ml - with a higher incidence of ACS patients with signs of pulmonary hypertension. In ACS, direct correlations of blood and urinary levels of NGAL with some echocardiographic parameters reflecting the systolic function and the LV dimensions and geometry were identified. Levels of u-NGAL were found to be positively correlated with blood levels NT-proBNP. NGAL may be used as a supplementary marker not only for acute kidney injury and chronic kidney disease but also for severity of cardiovascular conditions and heart remodeling in patients after exacerbation of ischemic heart disease.
研究中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为急性冠状动脉综合征（ACS）患者肾外并发症标志物的作用。
对110例住院1 - 3天的ACS患者，测定NGAL浓度，包括血清（s-NGAL）和尿液（u-NGAL）中的NGAL，以及B型利钠肽原N端片段（NT-proBNP），并进行经胸超声心动图检查。确定住院期间心血管并发症的发生率；入院时测量血流动力学参数（收缩压和舒张压、心率）。
急性心力衰竭（AHF）患者的u-NGAL浓度[10.4（2.7；51.2）ng/ml]显著高于无AHF患者[3.8（1.7；8.6）ng/ml，р = 0.03]。有[10.17（4.87；51.2 ng/ml）和744.6（368.7；2034.9）pg/ml]的患者u-NGAL和NT-proBNP浓度高于无肺动脉高压体征的患者[3.41（1.72；7.39）ng/ml；р = 0.004和431.8（99.6；780.1）pg/ml；р = 0.012]。u-NGAL值>9.96 ng/ml可预测AHF，值>5.81 ng/ml可预测肺动脉高压。u-NGAL水平与舒张末期内径和收缩末期内径值显著正相关，与舒张末期容积和射血分数值呈负相关；s-NGAL水平与心输出量和心脏指数呈正相关。u-NGAL水平与NT-proBNP值显著正相关。
有AHF或肺动脉高压体征的ACS患者尿中NGAL水平显著高于无这些情况的患者。NGAL值>9.96 ng/ml与住院期间AHF发生概率增加相关，NGAL值>5.81 ng/ml与有肺动脉高压体征的ACS患者较高发病率相关。在ACS中，发现血液和尿液中NGAL水平与一些反映收缩功能以及左心室大小和形态的超声心动图参数直接相关。发现u-NGAL水平与血液中NT-proBNP水平正相关。NGAL不仅可作为急性肾损伤和慢性肾病的补充标志物，还可作为缺血性心脏病加重后患者心血管疾病严重程度和心脏重塑的补充标志物。
