CAJ | 학술논문

目的评价尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和白细胞介素18(IL-18)水平检测在早期预测移植肾功能延迟恢复(DGF)中的价值.方法采用ELISA法,连续监测86例肾移植患者术前和术后12、24 h尿液标本中NGAL,IL-18及视黄醇结合蛋白(RBP)水平,并分析其与DGF的关系. 结果 86例中发生DGF 15例.术后12 h DGF组尿NGAL(ng/mg)水平明显高于非DGF组(1712.7±474.6比863.1±199.8,P<0.001),尿IL-18(ng/mg)水平与非DGF组比较差异无统计学意义(29.2±4.1比28.7±4.2,P>0.05);术后24 h DGF组尿NGAL和IL-18水平均明显高于非DGF组(分别为2905.0±1108.1比911.8±221.0,211.3±34.0比86.9±22.8,均P<0.001);而尿RBP(μg/mmol)(92.7±17.1比92.8±13.8,P>0.05)和SCr值(μmol/L)(608.1±85.5比542.3±99.6,P>0.05)与非DGF组比较差异无统计学意义.ROC曲线下面积分析结果显示,术后12 h尿NGAL曲线下面积为0.90,cut-off值为996.5 ng/mg时,诊断敏感性90.2%,特异性82.6%;术后24 h IL-18曲线下面积为0.76,cut-off值为148.5 ng/mg时,诊断敏感性76.3%,特异性66.4%. 结论尿NGAL及IL-18水平变化对早期预测DGF发生有重要的临床意义.
목적 평개뇨액중성립세포명효매상관지질운재단백(NGAL)화백세포개소18(IL-18)수평검측재조기예측이식신공능연지회복(DGF)중적개치.방법 채용ELISA법,련속감측86례신이식환자술전화술후12、24 h뇨액표본중NGAL,IL-18급시황순결합단백(RBP)수평,병분석기여DGF적관계. 결과 86례중발생DGF 15례.술후12 h DGF조뇨NGAL(ng/mg)수평명현고우비DGF조(1712.7±474.6비863.1±199.8,P<0.001),뇨IL-18(ng/mg)수평여비DGF조비교차이무통계학의의(29.2±4.1비28.7±4.2,P>0.05);술후24 h DGF조뇨NGAL화IL-18수평균명현고우비DGF조(분별위2905.0±1108.1비911.8±221.0,211.3±34.0비86.9±22.8,균P<0.001);이뇨RBP(μg/mmol)(92.7±17.1비92.8±13.8,P>0.05)화SCr치(μmol/L)(608.1±85.5비542.3±99.6,P>0.05)여비DGF조비교차이무통계학의의.ROC곡선하면적분석결과현시,술후12 h뇨NGAL곡선하면적위0.90,cut-off치위996.5 ng/mg시,진단민감성90.2%,특이성82.6%;술후24 h IL-18곡선하면적위0.76,cut-off치위148.5 ng/mg시,진단민감성76.3%,특이성66.4%. 결론 뇨NGAL급IL-18수평변화대조기예측DGF발생유중요적림상의의.
Objective To evaluate the predictive value of urinary neutrophil gelatinase-associat-ed lipocalin (NGAL) and interleukin-18 (IL-18) for delayed graft function (DGF) in kidney transplan-tation. Methods Serial urine samples collected at 0, 12 and 24 h after operation from 86 kidney transplantation patients were analyzed by enzyme-linked immunosorbent assay for NGAL, IL-18 and RBP. Results Fifteen patients developed DGF. At 12 h after transplantation, the level of urine NGAL elevated significantly (1712.75±474.6 vs. 863.1±199.8 without DGF, P<0. 001). The in-creases of urine IL-18 (29. 2±4.1 vs. 28.7±4.2 without DGF, P>0. 05) was not significant. At 24 h, both urine NGAL(2905.0±1108.1 vs. 911.8±221.0 without DGF,P<0. 001) and IL-18(211.3± 34.0 vs. 86.9±22.8 without DGF, P<0. 001) increased significantly, whereas the changes of urine RBP and serum creatinine (SCr) were not significant. ROC analysis showed that the area under the curve of NGAL and IL-18 were 0. 90 and 0.76 respectively, the cut-off values were 996.5 ng/mg and 148.5 ng/mg, the diagnostic sensitivities in DGF were 90.2% and 76.3%, specificities were 82.6% and 66.4% respectively. Conclusions Both urine NGAL and IL-18 could potentially be early predic-tive marker of DGF. The level of NGAL elevated earlier than IL-18, which may be more effective in predicting DGF.