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目的探讨尿液中性粒细胞明胶酶相关载脂蛋白(NGAL)应用于早期诊断对比剂肾病(CIN)的价值。方法在5个中心前瞻性收集行冠状动脉造影(CAG)患者的临床资料,将发生CIN者纳入CIN组(17例),另在入选患者中选取与CIN患者临床资料匹配的非CIN者纳入非CIN组(17例)。检测两组患者在CAG前后多个时间点的尿液NGAL、尿液N-乙酰-β-D氨基葡萄糖苷酶(NAG)、血清肌酐(sCr)、血清胱抑素C(CyC)水平,分析尿液NGAL作为CIN早期标志物的价值。结果 CIN组的CAG持续时间显著长于非CIN组(P<0.05)。CIN组在CAG后2、6、12、24h时的尿液NGAL水平均显著高于同组基线值(P值分别<0.05、0.01),非CIN组在CAG前后各时间点尿液NGAL水平的差异均无统计学意义(P值均>0.05),一直维持在较低水平。CIN组在CAG后6、12h时的尿液NGAL水平均显著高于非CIN组同时间点(P值分别<0.05、0.01)。CAG后6、12h时尿液NGAL值诊断CIN的受试者工作特征曲线下面积分别为0.713(95%CI为0.534～0.892,P=0.034)和0.772(95%CI为0.612～0.931,P=0.007)。CIN组在CAG后2、6h时的尿液NAG水平均显著高于同组基线值(P值均<0.05),非CIN组在CAG后2、6、12、24h时的尿液NAG水平均显著高于同组基线值(P值分别<0.05、0.01),两组间在CAG前后各时间点的尿液NAG水平的差异均无统计学意义(P值均>0.05)。CIN组在CAG后72h时的血清CyC水平均显著高于非CIN组同时间点(P<0.05),CAG后48、72h的sCr水平显著高于非CIN组同时间点(P值分别<0.01、0.05)。结论尿液NGAL对早期诊断CIN的价值优于尿液NAG、sCr及血清CyC。
Objective To investigate the value of urinary neutrophil gelatinase-associated apolipoprotein (NGAL) in the early diagnosis of contrast-induced nephropathy (CIN). Methods The clinical data of patients with coronary artery angiography (CAG) were prospectively collected in 5 centers. The patients with CIN were enrolled in the CIN group (17 cases), and the non-CIN patients who matched the clinical data of CIN patients were included in the selected patients CIN group (17 cases). Urinary NGAL, urinary NAG, serum creatinine (sCr) and serum cystatin C (CyC) were measured at two time points before and after CAG. The value of urinary NGAL as an early marker of CIN. Results The duration of CAG in CIN group was significantly longer than that in non-CIN group (P <0.05). Urinary NGAL levels in CIN group at 2, 6, 12, and 24 hours after CAG were significantly higher than those in the same group (P <0.05, 0.01 respectively). Urinary NGAL levels in non-CIN group before and after CAG There was no significant difference between the two groups (P> 0.05), always maintained at a low level. Urinary NGAL levels at 6 and 12 h after CAG in CIN group were significantly higher than those in non-CIN group (P <0.05 and 0.01 respectively). The area under the receiver operating characteristic curve for urinary NGAL values at 6 and 12 h after CAG were 0.713 (95% CI 0.534-0.892, P = 0.034) and 0.772 (95% CI 0.612-0.931, P = 0.007). The urinary NAG levels in CIN group at 2 and 6 hours after CAG were significantly higher than those in the same group (all P <0.05), while those in non-CIN group at 2, 6, 12 and 24 hours after CAG (P <0.05, 0.01 respectively). There was no significant difference in urine NAG levels between the two groups before and after CAG (P> 0.05). The level of serum CyC in CIN group at 72h after CAG was significantly higher than that in non-CIN group (P <0.05), while the level of sCr at 48 and 72h after CAG was significantly higher than that of non-CIN group (P <0.01 , 0.05). Conclusion Urine NGAL is superior to urine NAG, sCr and serum CyC in early diagnosis of CIN.