目的: 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）及肾损伤因子-1（kidney injury molecule-1,KIM-1）对急诊门诊肿瘤病人继发急性肾损伤（acute kidney injury,AKI）的早期诊断价值。方法: 收集2023年2月—2024年6月在河北某院急诊科门诊就诊的肿瘤病人102例作为研究对象,根据是否继发AKI分为AKI组（n=43）和non-AKI组（n=59）。应用ELISA方法检测尿液中NGAL、KIM-1水平,比较2组间NGAL、KIM-1的水平差异,分析其与血清肌酐水平（serum creatinine,Scr）及估算肾小球滤过率（estimated glomerular filtration rate,eGFR）的相关性,并绘制受试者工作曲线,评价单独或联合检测对AKI的早期诊断价值。结果: 与non-AKI组相比较,AKI组NGAL、KIM-1、NGAL/cr、KIM-1/cr水平均高于non-AKI组;NGAL、KIM-1截断值分别为112.514 μg/L、35.128 ng/L。NGAL、KIM-1、NGAL/cr、KIM-1/cr与Scr均呈正相关, 与eGFR均呈负相关。NGAL、KIM-1、NGAL/cr、KIM-1/cr诊断AKI的曲线下面积分别是0.847、0810、0.782、0.773;NGAL+KIM-1曲线下面积是0.856;NGAL/cr+KIM-1/cr曲线下面积是0.861。结论: 尿NGAL、KIM-1、NGAL/cr、KIM-1/cr与Scr呈正相关,与eGFR呈负相关,在AKI与non-AKI组间有显著差别,各指标均具有良好的诊断价值,且以尿NGAL/cr+ KIM-1/cr联合检测的诊断价值最高。
Abstract
Objective To explore the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1(KIM-1) for secondary acute kidney injury (AKI) in emergency department patients with tumors. Methods A total of 102 patients were included in the study and divided into AKI group (n=43) and non-AKI group (n=59). The levels of NGAL and KIM-1 in urine were detected by ELISA. The differences in NGAL and KIM-1 levels between the two groups were compared, and their correlations with serum creatinine (Scr) and estimated glomerular filtration rate (eGFR) were analyzed. Receiver operating characteristic (ROC) curves were drawn to evaluate the early diagnostic value of individual or combined detection of NGAL and KIM-1 for AKI. Results 1. Compared with the non-AKI group, the levels of NGAL, KIM-1, NGAL/cr, and KIM-1/cr in the AKI group were all higher, and the differences were statistically significant. The cut-off values of NGAL and KIM-1 were 112.514 μg/L and 35.128 ng/L, respectively.2. NGAL, KIM-1, NGAL/cr, and KIM-1/cr were positively correlated with Scr and negatively correlated with eGFR.3. The areas under the ROC curves for NGAL, KIM-1, NGAL/cr, and KIM-1/cr in diagnosing AKI were 0.847, 0.810, 0.782, and 0.773, respectively. The area under the ROC curve for NGAL + KIM-1 was 0.856, and that for NGAL/cr + KIM-1/cr was 0.861. Conclusion Urinary NGAL, KIM-1, NGAL/cr, and KIM-1/cr are positively correlated with Scr and negatively correlated with eGFR. There are significant differences between the AKI and non-AKI groups. All these indicators have good diagnostic value, and the combined detection of NGAL/cr + KIM-1/cr has the highest diagnostic value.
关键词
肿瘤 /
急诊 /
急性肾损伤 /
中性粒细胞明胶酶相关脂质运载蛋白 /
肾损伤因子-1
Key words
tumor /
acute kidney injury /
neutrophil gelatinase- associated lipocalin /
kidney injury molecule-1 /
serum creatinine
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基金
2023年河北省医学科学研究课题计划资助“NGAL对急诊肿瘤相关性急性肾损伤早期诊断价值的研究”（20230838）
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