尿乙酰-β-D-氨基葡萄糖苷酶在肝硬化合并急性肾损伤患者中的作用：多中心前瞻性队列研究
The Role of Urinary -Acetyl-β-d-glucosaminidase in Cirrhotic Patients with Acute Kidney Injury: Multicenter, Prospective Cohort Study.
作者信息
Yoo Jeong-Ju, Kwon Jung Hyun, Kim Young Seok, Nam Soon Woo, Park Ji Won, Kim Hee Yeon, Kim Chang Wook, Shin Seung Kak, Chon Young Eun, Jang Eun Sun, Jeong Sook-Hyang, Lee Jin Woo, Song Do Seon, Yang Jin Mo, Lee Sung Won, Lee Hae Lim, Jung Young Kul, Yim Hyung Joon, Lee Bora, Kim Sang Gyune, Kim Ju Hyun
机构信息
Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Seoul 14584, Korea.
Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon 21431, Korea.
出版信息
J Clin Med. 2021 Sep 23;10(19):4328. doi: 10.3390/jcm10194328.
BACKGROUND AND AIMS
Currently, it is difficult to predict the reversibility of renal function and to discriminate renal parenchymal injury in cirrhotic patients with acute kidney injury (AKI). The aim of this study is to evaluate whether urine -acetyl-β-d-Glucosaminidase (NAG) can predict the survival and response to terlipressin in cirrhotic patients with AKI.
METHODS
Two hundred sixty-two cirrhotic consecutive patients who developed AKI were prospectively enrolled from 11 tertiary medical centers in Korea between 2016 to 2019. AKI was defined as an increase in serum Cr (SCr) of 0.3 mg/dL or a 50% increase in baseline SCr. Patients diagnosed with hepatorenal syndrome (HRS-AKI) were treated with terlipressin plus albumin.
RESULTS
The patients were 58.8 ± 12.9 years old on average and were predominantly male (72.5%). The mean MELD score was 25.3 ± 9.1. When classified according to the AKI phenotype, there were 119 pre-renal, 52 acute tubular necrosis, 18 miscellaneous, and 73 HRS-AKI patients. However, the urine NAG was not effective at discriminating AKI phenotypes, except for HRS-AKI. The baseline urine NAG increased as the baseline AKI stage increased ( < 0.001). In addition, within the same AKI stage, the urine NAG values were significantly lower in the AKI-resolved group than in the unresolved group. The urine NAG level was significantly lower in living patients compared with those who died or who underwent a liver transplant within 3 months ( = 0.005). In the multivariate analysis, the increased urine NAG was a significant risk factor for the 3-month transplant-free survival (TFS) rate, especially in patients with Child-Pugh class ≤ B or MELD < 24. The urine NAG did not predict the response to terlipressin treatment in patients with HRS.
CONCLUSIONS
Urine NAG is strongly associated with the severity of AKI in patients with liver cirrhosis and is useful for predicting the 3-month TFS.
背景与目的
目前，预测肝硬化合并急性肾损伤（AKI）患者肾功能的可逆性以及鉴别肾实质损伤存在困难。本研究旨在评估尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）能否预测肝硬化合并AKI患者的生存率及对特利加压素的反应。
方法
2016年至2019年期间，从韩国11家三级医疗中心前瞻性纳入262例连续发生AKI的肝硬化患者。AKI定义为血清肌酐（SCr）升高0.3mg/dL或较基线SCr升高50%。诊断为肝肾综合征（HRS-AKI）的患者接受特利加压素联合白蛋白治疗。
结果
患者平均年龄为58.8±12.9岁，男性占主导（72.5%）。平均终末期肝病模型（MELD）评分为25.3±9.1。根据AKI表型分类，有119例肾前性、52例急性肾小管坏死、18例其他类型及73例HRS-AKI患者。然而，除HRS-AKI外，尿NAG对鉴别AKI表型无效。基线尿NAG随基线AKI分期增加而升高（<0.001）。此外，在相同AKI分期内，AKI缓解组的尿NAG值显著低于未缓解组。与在3个月内死亡或接受肝移植的患者相比，存活患者的尿NAG水平显著更低（=0.005）。在多变量分析中，尿NAG升高是3个月无移植生存率（TFS）的显著危险因素，尤其是在Child-Pugh分级≤B级或MELD<24的患者中。尿NAG不能预测HRS患者对特利加压素治疗的反应。
结论
尿NAG与肝硬化患者AKI的严重程度密切相关，对预测3个月TFS有用。
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