Department of Laboratory Medicine, Mianyang Central Hospital, Affiliated to Southwest Medical University, Mianyang.
Department of Laboratory Medicine, Pidu District People's Hospital, Chengdu, Sichuan, China.
Medicine (Baltimore). 2021 Apr 9;100(14):e25411. doi: 10.1097/MD.0000000000025411.
This study is to investigate the role of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine in the diagnosis of acute kidney injury (AKI) secondary to liver cirrhosis.A total of 825 patients (including 540 liver cirrhosis patients and 285 healthy controls) were enrolled. Liver cirrhosis patients were further subdivided into AKI secondary to liver cirrhosis group (AKI group, 210 patients) and simple liver cirrhosis group (LC group, 330 patients). Serum NGAL/urine NGAL (sNGAL/uNGAL), and serum creatinine (sCr) levels as well as estimated glomerular filtration rates were measured. The diagnostic performances of these indicators in AKI secondary to liver cirrhosis were evaluated.The levels of sNGAL, uNGAL, CysC and sCr in the AKI group were significantly higher than those of LC and healthy control groups. However, the eGFR and c-aGFR of AKI group were significantly lower. With the progression of AKI (AKI-S1→AKI-S2→AKI-S3), the levels of sNGAL, uNGAL, CysC and sCr increased gradually, while the levels of c-aGFR and eGFR decreased gradually. The sNGAL, uNGAL and CysC were positively correlated with sCr (r = 0.638, 0.635, and 0.650), but negatively correlated with c-aGFR (r = -0.617, -0.606 and -0.655). However, eGFR had a negative correlation with sCr (r = -0.711), but a positive correlation with c-aGFR (r = 0.736). ROC curve analysis showed that the area under the curve for uNGAL was the largest (0.976), followed by sNGAL (0.967). The diagnostic efficacy of uNGAL and sNGAL in AKI group were 0.907 and 0.870, and the risk degrees were OR = 54.524 and 5.115, respectively.NGAL might perform better than sCr and CysC in the diagnosis of AKI secondary to liver cirrhosis, while uNGAL might be a better indicator than sNGAL in AKI diagnosis.
本研究旨在探讨中性粒细胞明胶酶相关载脂蛋白（NGAL）、胱抑素 C（CysC）和肌酐在诊断肝硬化继发急性肾损伤（AKI）中的作用。共纳入 825 例患者（包括 540 例肝硬化患者和 285 例健康对照者）。肝硬化患者进一步分为肝硬化继发 AKI 组（AKI 组，210 例）和单纯肝硬化组（LC 组，330 例）。检测血清 NGAL/尿 NGAL（sNGAL/uNGAL）和血清肌酐（sCr）水平及估算肾小球滤过率（eGFR）。评估这些指标在诊断肝硬化继发 AKI 中的诊断性能。AKI 组的 sNGAL、uNGAL、CysC 和 sCr 水平明显高于 LC 组和健康对照组。然而，AKI 组的 eGFR 和 c-aGFR 明显降低。随着 AKI 的进展（AKI-S1→AKI-S2→AKI-S3），sNGAL、uNGAL、CysC 和 sCr 水平逐渐升高，而 c-aGFR 和 eGFR 水平逐渐降低。sNGAL、uNGAL 和 CysC 与 sCr 呈正相关（r = 0.638、0.635 和 0.650），与 c-aGFR 呈负相关（r = -0.617、-0.606 和 -0.655）。然而，eGFR 与 sCr 呈负相关（r = -0.711），与 c-aGFR 呈正相关（r = 0.736）。ROC 曲线分析显示，uNGAL 的曲线下面积最大（0.976），其次是 sNGAL（0.967）。uNGAL 和 sNGAL 在 AKI 组中的诊断效能分别为 0.907 和 0.870，风险度分别为 OR = 54.524 和 5.115。NGAL 可能比 sCr 和 CysC 更能诊断肝硬化继发 AKI，而 uNGAL 可能比 sNGAL 更能诊断 AKI。
