CAJ | 학술논문

目的探讨人中性粒细胞明胶酶相关脂质运载蛋白(NGAL)与2型肝肾综合征(HRS)患者预后的关系. 方法以54例2型HRS患者为研究对象,并对其随访6个月,根据随访情况,分为生存组25例和死亡组29例,单因素分析比较血、尿NGAL,血肾素、醛固酮及肝功能生物化学指标的差异,采用Cox比例风险回归模型进行多因素分析寻找2型HRS患者预后的影响因素.计量资料组间比较用t检验,多组间比较用方差分析;计数资料以相对数表示,组间比较用x2检验;相关分析采用Pearson相关分析;生存分析采用Cox比例风险回归模型的前进法. 结果 HRS组血红蛋白、血小板、白蛋白水平显著低于肝硬化组和对照组,差异均有统计意义(P＜ 0.05);HRS组INR、AST,ALT、总胆红素、直接胆红素、血肌酐、血NGAL、尿NGAL、血肾素和血醛固酮水平显著高于肝硬化组和对照组,差异均有统计意义(P＜ 0.05);血、尿NGAL与血肾素、血醛固酮、血肌酐、MELD评分、Child-Pugh评分和腹水等级均呈显著正相关(P＜0.05);生存组白蛋白、血钠、血肌酐、血NGAL、尿NGAL、血肾素、血醛固酮水平均显著低于死亡组,肾小球滤过率显著高于死亡组,差异均有统计学意义(P＜ 0.05);Cox比例风险回归模型结果表明对2型HRS患者6个月生存情况有显著影响的预后因素为MELD评分、血NGAL、总胆红素和血肌酐,其相对危险度分别为1.214、1.157、1.098和1.016.结论血NGAL在2型HRS患者中明显升高,是可预测其死亡风险的重要指标.
목적 탐토인중성립세포명효매상관지질운재단백(NGAL)여2형간신종합정(HRS)환자예후적관계. 방법 이54례2형HRS환자위연구대상,병대기수방6개월,근거수방정황,분위생존조25례화사망조29례,단인소분석비교혈、뇨NGAL,혈신소、철고동급간공능생물화학지표적차이,채용Cox비례풍험회귀모형진행다인소분석심조2형HRS환자예후적영향인소.계량자료조간비교용t검험,다조간비교용방차분석;계수자료이상대수표시,조간비교용x2검험;상관분석채용Pearson상관분석;생존분석채용Cox비례풍험회귀모형적전진법. 결과 HRS조혈홍단백、혈소판、백단백수평현저저우간경화조화대조조,차이균유통계의의(P＜ 0.05);HRS조INR、AST,ALT、총담홍소、직접담홍소、혈기항、혈NGAL、뇨NGAL、혈신소화혈철고동수평현저고우간경화조화대조조,차이균유통계의의(P＜ 0.05);혈、뇨NGAL여혈신소、혈철고동、혈기항、MELD평분、Child-Pugh평분화복수등급균정현저정상관(P＜0.05);생존조백단백、혈납、혈기항、혈NGAL、뇨NGAL、혈신소、혈철고동수평균현저저우사망조,신소구려과솔현저고우사망조,차이균유통계학의의(P＜ 0.05);Cox비례풍험회귀모형결과표명대2형HRS환자6개월생존정황유현저영향적예후인소위MELD평분、혈NGAL、총담홍소화혈기항,기상대위험도분별위1.214、1.157、1.098화1.016.결론 혈NGAL재2형HRS환자중명현승고,시가예측기사망풍험적중요지표.
Objective To investigate the effect of neutrophil gelatinase-associated lipocalin (NGAL) on prognosis of patients with type 2 hepatorenal syndrome (HRS).Methods A total of 54 patients with type 2 HRS were included in the study,and stratified for analysis according to survival status at 6-month followup:survival group,n =25; death group,n =29.Single factor analysis was used to compare the betweengroup differences for levels of plasma NGAL,urine NGAL,renin,aldosterone,and blood biochemical indicators.The Cox proportional hazard regression model was used to assess the prognosis of patients with type 2 HRS.The F-test,t-test,chi-square test,Pearson's correlation analysis,and Cox regression model were used for the statistical analyses.Results The HRS patients with liver cirrhosis showed significantly lower levels of hemoglobin,platelets and albumin (all P ＜ 0.05),but significantly higher international normalized ratio and levels of aspartate aminotransferase,alanine arninotransferase,total bilirubin,direct bilirubin,serum creatinine,plasma NGAL,urine NGAL,renin and aldosterone (all P ＜ 0.05).Plasma NGAL and urine NGAL were positively correlated with renin,aldosterone,blood creatinine,MELD score,Child-Pugh score and ascites (P ＜ 0.05).The patients in the 6-month survival group showed significantly lower levels of albumin,serum sodium,serum creatinine,plasma NGAL,urine NGAL,renin,and aldosterone than those in the death group (P ＜ 0.05),but significantly higher glomerular filtration rate (vs.death group,P ＜ 0.05).The Cox proportional hazard regression model showed that MELD,plasma NGAL,total bilirubin and creatinine were influencing factors of 6-month prognosis for patients with type 2 HRS (relative risk:1.214,1.157,1.098 and 1.016 respectively).Conclusion Plasma NGAL is high in patients with type 2 FHRS,and is associated with risk of death.