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目的:前瞻性研究尿N-乙酰-β-D氨基葡萄糖苷酶(N-acetyl-β-D-glucosaminidase,NAG)在经皮肾镜取石(percutaneous nephrolithotomy,PCNL)患者发生急性肾损伤中的诊断价值。方法:采集2011年10月~2013年1月期间住院的90例行PCNL手术患者的术前及术后相关病史资料,其中男64例,女26例,平均年龄(52.8±9.7)岁。采用比色法方法检测患者术前、术后尿液NAG水平,并检测血清肌酐值,进行综合分析。结果:PCNL术后,患者尿液NAG水平较术前有不同程度上升,术后各时间点尿液NAG活性均较术前显著升高,差异有统计学意义(P<0.05)。术后有11例发生急性肾损伤(acute kidney injury,AKI),79例未发生AKI。AKI组和非AKI组比较,两组年龄、性别比例、基础肌酐的差异无统计学意义(P>0.05),但手术时间、术后感染率、CRP、住院天数方面的差异有统计学意义(P<0.05)。术后2小时,AKI组NAG水平明显升高,且显著高于非AKI组(P<0.05)。ROC曲线分析术后24小时尿液NAG上升幅度百分比,当检测截点为235.44%时,曲线下面积为0.878(P<0.01),其诊断AKI敏感度为81.8%,特异度为91.1%。结论:PCNL术后发生AKI的患者尿NAG活性显著升高。其较血清肌酐更敏感、更早期地反映肾功能出现受损。手术时间、术后感染率可能是发生AKI的风险因子,尿NAG活性在PCNL术后早期诊断AKI具有一定的临床价值。
AIM: To prospectively study the diagnostic value of urinary N-acetyl-β-D-glucosaminidase (NAG) in the diagnosis of acute kidney injury in patients with percutaneous nephrolithotomy (PCNL) value. Methods: Preoperative and postoperative history data of 90 hospitalized patients with PCNL from October 2011 to January 2013 were collected, including 64 males and 26 females, with an average age of (52.8 ± 9.7) years. Colorimetric method was used to detect preoperative and postoperative urinary NAG levels, and serum creatinine was measured for comprehensive analysis. Results: The urine NAG level in patients with PCNL increased to some extent compared with that before operation. The urine NAG activity at each time point after operation was significantly higher than that before operation (P <0.05). There were 11 cases of acute kidney injury (AKI) and 79 cases of no AKI. AKI group and non-AKI group, the two groups of age, sex ratio, basal creatinine difference was not statistically significant (P> 0.05), but the operation time, postoperative infection rate, CRP, length of stay were statistically significant P <0.05). After 2 hours, the level of NAG in AKI group was significantly higher than that in non-AKI group (P <0.05). ROC curve analysis of urine NAG rise percentage of 24 hours, when the test cut-off point was 235.44%, the area under the curve was 0.878 (P <0.01), the diagnosis of AKI sensitivity was 81.8%, specificity was 91.1%. Conclusions: Urinary NAG activity in patients with AKI after PCNL is significantly increased. It is more sensitive than serum creatinine and reflects earlier impaired renal function. The operation time and postoperative infection rate may be the risk factors of AKI. Urinary NAG activity has some clinical value in the early diagnosis of AKI after PCNL.