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目的:探讨尿中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、尿肾损伤分子-1(kidneyinjury molecule-1,Kim-1)、尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acecyl-β-D-glucosaminidase,NAG)、尿微量白蛋白(mALB)在重症感染中合并急性肾损伤的敏感性及临床价值。方法:回顾分析60例在新疆自治区人民医院ICU住院的重症感染合并急性肾损伤(AKI)患者的尿NGAL、Kim-1、NAG及mALB的变化情况。健康体检者20例为对照组。尿NGAL、Kim-1、mALB测定采用酶联免疫法(ELISA)检测,尿NAG测定采用对硝基苯酚(PNP)比色法检测,并以ROC曲线分析其敏感性。结果:AKI组患者尿液中的NGAL、Kim-1、NAG、mALB的测定浓度明显高于对照组,差异具有统计学意义(P<0.001),通过ROC曲线、诊断试验结果显示:尿NGAL、Kim-1曲线下面积分别为0.986、0.956,95%可信区间分别是0.968～1.004、0.910～1.001,较尿NAG、mALB更具有敏感性(P<0.001)。结论:尿NGAL、尿Kim-1的浓度检测对重症感染合并急性肾损伤的诊断更具有敏感性,与NAG、mALB联合检测有助于急性肾损伤的早期监测,对预防急性肾损伤的发生、发展具有重要的临床价值。
Objective: To investigate the relationship between urinary neutrophil gelatinase-associated lipocalin (NGAL), urinary kidney injury molecule-1 (Kim-1), urinary N-acetyl-β- Sensitivity and clinical value of N-acecyl-β-D-glucosaminidase (NAG) and microalbuminuria (MALB) in acute renal injury complicated by severe infection. Methods: The changes of urinary NGAL, Kim-1, NAG and mALB in 60 patients with severe infection and acute kidney injury (AKI) hospitalized in ICU of People’s Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. Twenty healthy subjects were control group. The urinary NGAL, Kim-1 and mALB were detected by enzyme-linked immunosorbent assay (ELISA). The urinary NAG was detected by p-nitrophenol (PNP) colorimetric assay and the sensitivity was analyzed by ROC curve. Results: The urinary concentrations of NGAL, Kim-1, NAG and mALB in AKI group were significantly higher than those in control group (P <0.001). According to the ROC curve, the diagnostic results of urine NGAL, The area under the curve of Kim-1 were 0.986,0.956 and 95% confidence intervals were 0.968-1.004 and 0.910-1.01 respectively, which were more sensitive than urine NAG and mALB (P <0.001). Conclusion: The detection of urinary NGAL and urinary Kim-1 concentration is more sensitive to the diagnosis of severe acute kidney injury. Combined with NAG and mALB, it is helpful for the early detection of acute renal injury. It is of great value in the prevention of acute kidney injury, Development has important clinical value.