入院首日血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肌酐在1型心肾综合征诊断中的价值
Value of Plasma NGAL and Creatinine on First Day of Admission in the Diagnosis of Cardiorenal Syndrome Type 1.
作者信息
Phan Thai Hao, Hoang Bui Bao, Hoang Anh Tien, Huynh Van Minh
机构信息
Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.
Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
出版信息
Cardiol Res Pract. 2020 Oct 6;2020:2789410. doi: 10.1155/2020/2789410. eCollection 2020.
BACKGROUND
The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is a very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. This study was aimed to evaluate the diagnostic efficacy of plasma NGAL in the diagnosis of CRS1.
METHODS
There were 139 patients with AHF or ADHF in the department of Cardiovascular Resuscitation and Interventional Cardiology at Ho Chi Minh City 115 People Hospital from September 2018 to March 2019. This was a prospective cohort study.
RESULTS
There were 48 cases (rate 34.5%) with CRS1, mean age was 66.12 ± 15.77 and men accounted for 50.4%. There were no significant differences of vital signs at admission, diagnosis, and EF-based heart failure between CRS1 and non-CRS1 groups. The urea, creatinine on first day (creatinine D1) and third day (creatinine D3), NT-proBNP, and NGAL levels were higher in the CRS1 group than the non-CRS1 group, < 0.05. The optimal cutoff plasma NGAL for diagnosing CRS1 was >353.23 ng/ml, area under curve (AUC) 0.732 (95% CI 0.65-0.80, < 0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, and negative predictive value 84%. Multivariable logistic regression analysis eGFR remained the strongest independent predictor of CRS1. Building the optimal regression model (without eGFRCKDEPID1) by the BMA (Bayesian model average) method with two variables NGAL and Creatinine D1, we had the equation: odds ratio = e while y = -2.39 + 0.0037 × NGAL + 0.17 × Creatinine D1. The nomogram (without eGFR) was designed to predict the likelihood of CRS1 with AUC 0.79.
CONCLUSIONS
The combination of plasma NGAL and creatinine D1 on the first day at admission had a high accuracy of predictive model for CRS1.
背景
急性心力衰竭（AHF）或急性失代偿性心力衰竭（ADHF）患者中急性肾损伤很常见，被称为心肾综合征1型（CRS1）。血液和尿液中的中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是缺血或肾毒性所致急性肾损伤最早的生物标志物之一。本研究旨在评估血浆NGAL对CRS1的诊断效能。
方法
2018年9月至2019年3月，胡志明市第115人民医院心血管复苏与介入心脏病科有139例AHF或ADHF患者。这是一项前瞻性队列研究。
结果
有48例（发生率34.5%）CRS1患者，平均年龄为66.12±15.77岁，男性占50.4%。CRS1组和非CRS1组入院时生命体征、诊断及基于射血分数的心力衰竭情况无显著差异。CRS1组的尿素、第1天（肌酐D1）和第3天（肌酐D3）的肌酐、N末端脑钠肽前体（NT-proBNP）及NGAL水平高于非CRS1组，P<0.05。诊断CRS1的最佳血浆NGAL截断值>353.23 ng/ml，曲线下面积（AUC）为0.732（95%可信区间0.65 - 0.80，P<0.001），敏感性74.47%，特异性6,8.48%，阳性预测值54.7%，阴性预测值84%。多变量逻辑回归分析显示估算肾小球滤过率（eGFR）仍是CRS1最强的独立预测因子。采用贝叶斯模型平均法（BMA）用NGAL和肌酐D1两个变量建立最佳回归模型（不包括eGFR、肌酐、NT-proBNP、D1），方程为：比值比 = e ，而y = -2.39 + 0.0037×NGAL + 0.17×肌酐D1。设计了列线图（不包括eGFR）来预测CRS1的可能性，AUC为0.79。
结论
入院第1天血浆NGAL和肌酐D1的联合对CRS1预测模型具有较高的准确性。
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