Pan Jing-Jing, Sun Zhong-Yi, Zhou Xiao-Yu, Hu Yu-Hua, Cheng Rui, Chen Xiao-Qing, Yang Yang
Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
J Res Med Sci. 2018 Oct 26;23:90. doi: 10.4103/jrms.JRMS_112_18. eCollection 2018.
The objective of this study is to evaluate the value of neutrophil gelatinase-associated lipocalin (NGAL) for becoming a good endogenous marker of renal function in asphyxial preterm babies.
This is a two-center retrospective study. Between October 2016 and October 2017, 71 asphyxial preterm infants were included in asphyxia group. Seventy babies were randomly included in control group. Samples were tested at 24, 48, and 96 h after birth. Quantitative data were compared by independent sample -test or repeated measures ANOVA. For qualitative data, Pearson's Chi-squared test was performed. Draw ROC and compare the area under the curve (AUC), 95% confidence interval for AUC, specificity (Spe), sensitivity (Sen), and Youden index (Sen+Spe-1) at 24-h, 48-h, and 96-h time points.
(1) There are no significant differences concerning on baseline data. However, blood gas, Apgar score, and resuscitation showed a significant difference ( < 0.05). (2) In 24-h samples, only uNGAL and estimated glomerular filtration rate (eGFR) showed differences between the two groups ( < 0.05). In 48-h samples, significant differences could be found in uKIM-1, uNGAL, blood urea nitrogen, and eGFR ( < 0.05). In 96-h samples, almost all indicators have significant differences except urine output and eGFR ( < 0.05). (3) All biomarkers showed statistical difference in the three time points ( < 0.05), but only uNGAL showed a downward trend after the increase of expression. (4) uNGAL has better Sen and Spe than other indicators (24-h AUC 0.870, Youden index 0.606; 48-h AUC 0.879, Youden index 0.692; and 96-h AUC 0.806, Youden index 0.606).
uNGAL has a better distinguishability in asphyxial neonates compared with other indicators. Certainly, a larger sample, prospective study is still needed.
本研究的目的是评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为窒息早产儿肾功能良好内源性标志物的价值。
这是一项双中心回顾性研究。2016年10月至2017年10月期间，71例窒息早产儿被纳入窒息组。70例婴儿被随机纳入对照组。在出生后24、48和96小时进行样本检测。定量数据采用独立样本t检验或重复测量方差分析进行比较。对于定性数据，进行Pearson卡方检验。绘制ROC曲线并比较24小时、48小时和96小时时间点的曲线下面积（AUC）、AUC的95%置信区间、特异性（Spe）、敏感性（Sen）和尤登指数（Sen+Spe-1）。
（1）基线数据无显著差异。然而，血气、阿氏评分和复苏情况存在显著差异（P<0.05）。（2）在24小时样本中，只有尿NGAL和估计肾小球滤过率（eGFR）在两组之间存在差异（P<0.05）。在48小时样本中，尿KIM-1、尿NGAL、血尿素氮和eGFR存在显著差异（P<0.05）。在96小时样本中，除尿量和eGFR外，几乎所有指标都存在显著差异（P<0.05）。（3）所有生物标志物在三个时间点均显示出统计学差异（P<0.05），但只有尿NGAL在表达升高后呈下降趋势。（4）尿NGAL比其他指标具有更好的敏感性和特异性（24小时AUC为0.870，尤登指数为0.606；48小时AUC为0.879，尤登指数为0.692；96小时AUC为0.806，尤登指数为0.606）。
与其他指标相比，尿NGAL在窒息新生儿中具有更好的区分能力。当然，仍需要更大样本的前瞻性研究。
