Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
PLoS One. 2020 Apr 2;15(4):e0230934. doi: 10.1371/journal.pone.0230934. eCollection 2020.
There are still limited studies comprehensively examining the diagnostic performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in contrast-induced nephropathy (CIN). The study aimed to investigate and compare the predictive value of NGAL and cystatin C in the early diagnosis of CIN.
We searched the PubMed, EMBASE and Cochrane Library databases until November 10, 2019. The methodological quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Bivariate modeling and hierarchical summary receiver operating characteristic (HSROC) modeling were performed to summarize and compare the diagnostic performance of blood/urine NGAL and serum cystatin C in CIN. Subgroup and meta-regression analyses were performed according to the study and patient characteristics.
Thirty-seven studies from thirty-one original studies were included (blood NGAL, 1840 patients in 9 studies; urine NGAL, 1701 patients in 10 studies; serum cystatin C, 5509 patients in 18 studies). Overall, serum cystatin C performed better than serum/urine NGAL (pooled DOR: 43 (95%CI: 12-152); AUROC: 0.93; λ: 3.79); serum and urine NGAL had a similar diagnostic performance (pooled DOR: 25 (95%CI: 6-108)/22(95%CI: 8-64); AUROC: 0.90/0.89; λ: 3.20/3.08). Meta-regression analysis indicated that the sources of heterogeneity might be CIN definition, assays, and nationalities.
Both NGAL and cystatin C can serve as early diagnostic indicators of CIN, while cystatin C may perform better than NGAL.
目前，全面评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素 C 在造影剂肾病（CIN）中的诊断性能的研究仍然有限。本研究旨在探讨并比较 NGAL 和胱抑素 C 在 CIN 早期诊断中的预测价值。
我们检索了 PubMed、EMBASE 和 Cochrane Library 数据库，检索时间截至 2019 年 11 月 10 日。使用 QUADAS-2 工具评估纳入研究的方法学质量。采用双变量模型和分层汇总受试者工作特征（HSROC）模型，对血液/尿液 NGAL 和血清胱抑素 C 在 CIN 中的诊断性能进行总结和比较。根据研究和患者特征进行亚组和荟萃回归分析。
从 31 项原始研究中纳入 37 项研究（血液 NGAL，9 项研究 1840 例患者；尿液 NGAL，10 项研究 1701 例患者；血清胱抑素 C，18 项研究 5509 例患者）。总体而言，血清胱抑素 C 的表现优于血清/尿液 NGAL（汇总 DOR：43（95%CI：12-152）；AUROC：0.93；λ：3.79）；血清和尿液 NGAL 的诊断性能相似（汇总 DOR：25（95%CI：6-108）/22（95%CI：8-64）；AUROC：0.90/0.89；λ：3.20/3.08）。荟萃回归分析表明，异质性的来源可能是 CIN 定义、检测方法和国家。
NGAL 和胱抑素 C 均可作为 CIN 的早期诊断指标，而胱抑素 C 的表现可能优于 NGAL。
