CAJ | 학술논문

目的：探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）与慢性肾脏病（CKD）肾小管间质损伤的相关性。方法测定124例行肾穿刺的CKD患者及30名健康体检者（正常对照组）血清半胱氨酸蛋白酶抑制剂C （Cys C）、尿NGAL、尿视黄醇结合蛋白（RBP）、尿β2-微球蛋白（β2-MG）水平，对尿NGAL与血清Cys C、尿RBP、尿β2-MG进行相关性分析。依据肾穿刺活检结果将肾小管间质损伤程度分为轻度损伤、轻-中度损伤、中度损伤、中-重度损伤4组，采用Spearman等级相关分析尿NGAL与肾小管间质损伤程度的相关性。采用受试者工作特征（ ROC）曲线评价尿NGAL诊断CKD肾小管间质损伤的性能。结果 CKD各组尿NGAL均明显高于正常对照组（P均＝0．000），随着肾小管间质损伤程度的加重，尿 NGAL 水平逐渐升高，各组间差异均有统计学意义（P均＜0．05）。尿NGAL与尿RBP、尿β2-MG和血清Cys C均呈正相关（r＝0．784、0．692、0．759，P均＜0．01）。尿NGAL水平与肾小管间质损伤程度呈正相关（r＝0．762，P＜0．01）。尿NGAL诊断CKD肾小管间质损伤的ROC曲线下面积为0．855；当最佳临界点为45．35 ng／mL时，敏感性为77．2％，特异性为84．6％。结论尿NGAL可以作为反映CKD肾小管间质损伤的标志物，对于CKD诊断、治疗和预后具有一定的临床意义。
목적：탐토뇨중성립세포명효매상관지질운재단백（NGAL）여만성신장병（CKD）신소관간질손상적상관성。방법측정124례행신천자적CKD환자급30명건강체검자（정상대조조）혈청반광안산단백매억제제C （Cys C）、뇨NGAL、뇨시황순결합단백（RBP）、뇨β2-미구단백（β2-MG）수평，대뇨NGAL여혈청Cys C、뇨RBP、뇨β2-MG진행상관성분석。의거신천자활검결과장신소관간질손상정도분위경도손상、경-중도손상、중도손상、중-중도손상4조，채용Spearman등급상관분석뇨NGAL여신소관간질손상정도적상관성。채용수시자공작특정（ ROC）곡선평개뇨NGAL진단CKD신소관간질손상적성능。결과 CKD각조뇨NGAL균명현고우정상대조조（P균＝0．000），수착신소관간질손상정도적가중，뇨 NGAL 수평축점승고，각조간차이균유통계학의의（P균＜0．05）。뇨NGAL여뇨RBP、뇨β2-MG화혈청Cys C균정정상관（r＝0．784、0．692、0．759，P균＜0．01）。뇨NGAL수평여신소관간질손상정도정정상관（r＝0．762，P＜0．01）。뇨NGAL진단CKD신소관간질손상적ROC곡선하면적위0．855；당최가림계점위45．35 ng／mL시，민감성위77．2％，특이성위84．6％。결론뇨NGAL가이작위반영CKD신소관간질손상적표지물，대우CKD진단、치료화예후구유일정적림상의의。
Objective To study the correlation of urinary neutrophil gelatinase-associated lipocalin ( NGAL) with chronic kidney disease ( CKD) renal tubulointerstitial injury .Methods A total of 30 healthy subjects ( healthy control group) and 124 patients with CKD undergoing renal biopsy were enrolled .Serum cystatin C (Cys C), urinary NGAL, urinary retinol binding protein (RBP) and urinary beta2-microglobulin (β2-MG) were determined.Correlation analysis was carried out on urinary NGAL with serum Cys C , urinary RBP and urinary β2-MG.According to the degrees of renal biopsy results , renal tubulointerstitial injury was classified into mild injury , mild to moderate injury , moderate injury and severe injury groups .By Spearman rank , the correlation of urinary NGAL with CKD renal tubulointerstitial injury was analyzed.The performance of urinary NGAL for the diagnosis of CKD renal tubulointerstitial injury was analyzed by receiver operating characteristic (ROC) curve.Results The urinary NGAL of CKD groups was significantly higher than that of control group (P=0.000).With the increasing of CKD renal tubulointerstitial injury , urinary NGAL increased gradually, and the differences were statistically significant (P<0.05).The urinary NGAL was positively correlated with urinary RBP, urinary β2-MG and serum Cys C (r =0.784, 0.692 and 0.759, P <0.01).There was positive correlation between urinary NGAL and renal tubulointerstitial injury (r=0.762, P<0.01).The area under ROC curve was 0.855, and the optimal cut-off point was 45.35 ng/mL.The sensitivity was 77.2%, and the specificity was 84.6%. Conclusions Urinary NGAL contributes to the diagnosis , treatment and prognosis of CKD renal tubulointerstitial injury , which is a novel biomarker for the disease .