尿中性粒细胞明胶酶相关脂质运载蛋白作为住院肝硬化患者急性肾损伤的诊断和预后标志物：一项来自北印度人群的研究
Urinary Neutrophil Gelatinase-associated Lipocalin as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Hospitalized Cirrhotic Patients: A Study from North Indian Population.
作者信息
Patel Munna Lal, Shyam Radhey, Chaudhary Anurag, Sachan Rekha, Ali Wahid
机构信息
Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Geriatric Mental Health and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India.
出版信息
Indian J Crit Care Med. 2023 Aug;27(8):545-551. doi: 10.5005/jp-journals-10071-24497.
BACKGROUND
A serious problem in cirrhosis is acute renal injury. The study aimed to examine the urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic and prognostic marker of acute kidney injury (AKI) in cirrhotic patients.
METHODS
A prospective study was carried out over a period of 1 year. A total of 490 patients suffering from cirrhosis who visited an indoor hospital were screened, and after the exclusion, a total of 90 subjects admitted to the medicine intensive care unit (MICU) fulfilling inclusion criteria were enrolled. Those having a history of renal diseases, on nephrotoxic drugs, in septic shock, peritonitis, UTI, and no urine output were excluded. On admission, for the estimation of uNGAL, urinary levels of sodium, creatinine, fresh urine samples were obtained, and blood samples were taken for serum creatinine estimation.
RESULTS
Out of 90 patients, 33.3% did not develop AKI, and 66.7% developed AKI. Urinary neutrophil gelatinase-associated lipocalin levels were six times higher in patients with acute tubular necrosis (259.08 ± 118.41 ng/mL) and three times higher in Hepatorenal syndrome (HRS)-AKI (124.97 ± 16.38) as compared with patients with normal kidney function (39.76 + 5.7). Those who died had a higher uNGAL (171.6 ng/mL) in comparison to those who survived (133.7 ng/mL). At a cutoff value of ≥114.9 (ng/mL), urinary NGAL represents a sensitivity of 86.92% and specificity of 100% to diagnose AKI and AUC 0.966 (95% CI: 0.919-0.990) in cirrhotic patients.
CONCLUSION
Urinary NGAL is good for diagnosing AKI and is a marker to distinguish the types of AKI in liver cirrhosis.
HOW TO CITE THIS ARTICLE
Patel ML, Shyam R, Chaudhary A, Sachan R, Ali W. Urinary Neutrophil Gelatinase-associated Lipocalin as a Diagnostic and Prognostic Marker for Acute Kidney Injury in Hospitalized Cirrhotic Patients: A Study from North Indian Population. Indian J Crit Care Med 2023;27(8):545-551.
背景
肝硬化中的一个严重问题是急性肾损伤。本研究旨在检测尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）作为肝硬化患者急性肾损伤（AKI）的诊断和预后标志物。
方法
进行了为期1年的前瞻性研究。对490名到内科医院就诊的肝硬化患者进行筛查，排除后，共有90名符合纳入标准并入住内科重症监护病房（MICU）的受试者被纳入研究。排除有肾脏疾病史、正在使用肾毒性药物、处于感染性休克、腹膜炎、尿路感染且无尿的患者。入院时，为了检测uNGAL，获取尿钠、肌酐水平的新鲜尿液样本，并采集血样用于血清肌酐检测。
结果
90名患者中，33.3%未发生AKI，66.7%发生了AKI。与肾功能正常的患者（39.76 + 5.7）相比，急性肾小管坏死患者的尿中性粒细胞明胶酶相关脂质运载蛋白水平高6倍（259.08 ± 118.41 ng/mL），肝肾综合征（HRS）-AKI患者的该水平高3倍（124.97 ± 16.38）。死亡患者的uNGAL水平（171.6 ng/mL）高于存活患者（133.7 ng/mL）。在截断值≥114.9（ng/mL）时，尿NGAL诊断肝硬化患者AKI的灵敏度为86.92%，特异性为100%，曲线下面积为0.966（95%CI：0.919 - 0.990）。
结论
尿NGAL有助于诊断AKI，是区分肝硬化患者AKI类型的标志物。
如何引用本文
帕特尔ML，夏姆R，乔杜里A，萨昌R，阿里W。尿中性粒细胞明胶酶相关脂质运载蛋白作为住院肝硬化患者急性肾损伤的诊断和预后标志物：一项来自北印度人群的研究。《印度重症医学杂志》2023；27(8):545 - 551。
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