CAJ | 학술논문

目的探讨尿肝型脂肪酸结合蛋白(uL-FABP)、尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)诊断梗阻性肾病所致急性肾损伤(AKI)和预测肾脏预后的价值.方法前瞻性收集30例梗阻性肾病患者解除梗阻前后不同时相的尿液标本,应用ELISA法检测uL-FABP、uNGAL水平.对不同时相、是否发生AKI等情况进行分析比较.对这2个指标与其他临床指标进行相关分析.随访1年,评估uL-FABP、uNGAL对梗阻性肾病肾脏的预后价值.结果与非AKI患者相比,AKI患者的uL-FABP和uNGAL水平显著升高[700.00(154.62～1216.14) μg/g·Cr比26.90(16.77～41.38) μg/g·Cr;1266.69(671.57～3396.07) μg/g· Cr比179.12(90.98～215.16) μg/g· Cr,均P＜0.01].uL-FABP、uNGAL与Scr呈正相关(r=0.552,0.553,均P＜ 0.01)；两者预测AKI的受试者工作特征(ROC)曲线下面积(AUC)分别为0.925和0.900.随访1年时肾功能未恢复患者各时间点uL-FABP水平均显著高于肾功能恢复组(均P＜0.01).术前uL-FABP水平在肾脏预后判断中的AUC为0.948,敏感度为85.7％,特异度为90.9％；术后72 h uL-FABP在肾脏预后判断中的AUC为0.935,敏感度为85.7％,特异度为90.9％.Kaplan-Meier生存曲线分析显示,术前uL-FABP＞ 366.57 μg/g· Cr或术后72 h uL-FABP＞223.60 μg/g· Cr,与不良预后呈明显相关性.结论 uL-FABP、uNGAL对诊断梗阻性肾病所致AKI有较高的准确性.术前及术后72 h uL-FABP有助于判断梗阻性肾病的肾脏预后.
목적 탐토뇨간형지방산결합단백(uL-FABP)、뇨중성립세포명효매상관지질운재단백(uNGAL)진단경조성신병소치급성신손상(AKI)화예측신장예후적개치.방법 전첨성수집30례경조성신병환자해제경조전후불동시상적뇨액표본,응용ELISA법검측uL-FABP、uNGAL수평.대불동시상、시부발생AKI등정황진행분석비교.대저2개지표여기타림상지표진행상관분석.수방1년,평고uL-FABP、uNGAL대경조성신병신장적예후개치.결과 여비AKI환자상비,AKI환자적uL-FABP화uNGAL수평현저승고[700.00(154.62～1216.14) μg/g·Cr비26.90(16.77～41.38) μg/g·Cr;1266.69(671.57～3396.07) μg/g· Cr비179.12(90.98～215.16) μg/g· Cr,균P＜0.01].uL-FABP、uNGAL여Scr정정상관(r=0.552,0.553,균P＜ 0.01)；량자예측AKI적수시자공작특정(ROC)곡선하면적(AUC)분별위0.925화0.900.수방1년시신공능미회복환자각시간점uL-FABP수평균현저고우신공능회복조(균P＜0.01).술전uL-FABP수평재신장예후판단중적AUC위0.948,민감도위85.7％,특이도위90.9％；술후72 h uL-FABP재신장예후판단중적AUC위0.935,민감도위85.7％,특이도위90.9％.Kaplan-Meier생존곡선분석현시,술전uL-FABP＞ 366.57 μg/g· Cr혹술후72 h uL-FABP＞223.60 μg/g· Cr,여불량예후정명현상관성.결론 uL-FABP、uNGAL대진단경조성신병소치AKI유교고적준학성.술전급술후72 h uL-FABP유조우판단경조성신병적신장예후.
Objective To evaluate the values of urinary liver-fatty acid binding protein (uL-FABP) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosis of acute kidney injury (AKI) caused by obstructive nephropathy and in the prediction of renal prognosis.Methods Clinical data of 30 patients with obstructive nephropathy were collected prospectively.uL-FABP and uNGAL were measured by ELISA at various time points.Risk factors of the renal outcome were evaluated.The patients were followed up for at least one year.Results Patients with AK1 had higher levels of uL-FABP and uNGAL compared to those without AKI [700.00(154.62-1216.14) μg/g· Cr vs 26.90 (16.77-41.38) μg/g·Cr; 1266.69 (671.57-3396.07) μg/g·Cr vs 179.12 (90.98-215.16) μg/g·Cr,all P ＜ 0.01].Positive correlations of uL-FABP and uNGAL with serum creatinine were found (r =0.552,0.553,all P ＜ 0.01).The AUCs of uL-FABP and uNGAL to detect AKI were 0.925 and 0.900.Patients with non complete renal recovery had higher levels of uL-FABP before operation and 72-hour after operation compared to those with complete renal recovery (all P ＜ 0.01).Before operation,the AUC of uL-FABP to detect renal prognosis was 0.948,sensitivity was 85.7％ and specificity was 90.9％.72-hour after operation,the AUC of uL-FABP to detect renal prognosis was 0.935,sensitivity was 85.7％ and specificity was 90.9％.Kaplan-Meier analysis revealed that uL-FABP before operation over 366.57 μg/g · Cr or uL-FABP 72-hour after operation over 223.60 μg/g · Cr were closely related to the poor progression of renal function.Conclusions uL-FABP and uL-NGAL have good accuracy in detecting AKI.The level of uL-FABP before operation and 72-hour after operation is helpful to predict the renal outcome of obstructive nephropathy.