目的 观察脓毒症干预与否情况下尿中性粒细胞明胶酶相关载脂蛋白(uNGAL)质量浓度变化特点并评价其对急性肾损伤(AKI)的诊断价值.方法 56只SD(Sprague Dawley)大鼠随机(随机数字法)分为4组,模型组(CLG) 16只、血必净组(XBG) 16只、黄芪注射液和柴胡注射液合用组(HCG) 16只及假手术组(SOG)8只.CLG组、HCG组和XBG组以盲肠结扎穿孔术(CLP)制作脓毒症模型,造模后HCG组腹腔注射黄芪注射液和柴胡注射液;XBG组静脉注射血必净注射液;SOG组只开腹不行CLP.于术前(0 h)、术后6h、12h、18h、24 h、36 h、48 h和72 h留取血清和尿液,检测血清肌酐(sCr)、尿肌酐(uCr)、尿钠(uNa)和uNGAL.绘制uNGAL质量浓度随时间变化曲线,Logistic回归分析首个6h尿量、6h处uNa和6h处uNGAL与24 h内发生AKI的关系,计算受试者工作曲线(ROC)下面积(AUC).结果 CLG组、HCG组和XBG组大鼠的uNGAL均于造模后6h内迅速升高,峰值分别出现于6h处(CLG组)、24 h处(HCG组和XBG组),后均快速下降;三组大鼠经同时间点uCr校正的uNGAL (cuNGAL)于造模后6h内迅速升高,峰值均出现在24 h处.CLG组大鼠中发生AKI与未发生AKI大鼠的uNGAL或cuNGAL随时间变化曲线几近重叠,在各时间点的浓度差异无统计学意义(uNGAL:6 h,t=0.691; 12h,t=1.627; 18h,t=0.511. cuNGAL:6h,t=0.371; 12h,t =0.474; 18h,t=-1.187;均P＞0.05);XBG组uNGAL或cuNGAL随时间变化曲线不重叠,各时间点的质量浓度差异无统计学意义(uNGAL:6 h,t=1.222;12 h,t=1.178;18 h,t=1.272; 24h,=0.918; 36 h,t=0.442. cuNGAL:6 h,t=1.482; 12h,t=1.314; 18h,t=1.280; 24h,t=0.280; 36h,=0.467.均P＞0.05).HCG组,发生AKI大鼠的uNGAL随时间变化曲线自6h后各个时间点上升幅度明显高于未发生AKI大鼠(6h,t=2.351,P＜0.05;12 h,t=3.086,P＜0.01; 18h,t=2.535,P＜0.05;24h,t=2.150,P＜0.05;36 h,t=2.485,P＜0.05),6h、18 h和24h处发生与未发生AKI大鼠的cuNGAL均值间差异具有统计学意义(6h,t=3.013,P＜0.01; 18 h,t=4.804,P＜0.01; 24 h,t=2.682,P＜ 0.05).6h处Uout可提高cuNGAL对24h内发生AKI预测能力(AUC由0.839提高至0.900,P＜0.05).结论 脓毒症时施加的干预措施会影响尿中NGAL的分泌量和分泌时序;uNGAL和cuNGAL是脓毒症大鼠发生AKI的良好预测因子.
目的 觀察膿毒癥榦預與否情況下尿中性粒細胞明膠酶相關載脂蛋白(uNGAL)質量濃度變化特點併評價其對急性腎損傷(AKI)的診斷價值.方法 56隻SD(Sprague Dawley)大鼠隨機(隨機數字法)分為4組,模型組(CLG) 16隻、血必淨組(XBG) 16隻、黃芪註射液和柴鬍註射液閤用組(HCG) 16隻及假手術組(SOG)8隻.CLG組、HCG組和XBG組以盲腸結扎穿孔術(CLP)製作膿毒癥模型,造模後HCG組腹腔註射黃芪註射液和柴鬍註射液;XBG組靜脈註射血必淨註射液;SOG組隻開腹不行CLP.于術前(0 h)、術後6h、12h、18h、24 h、36 h、48 h和72 h留取血清和尿液,檢測血清肌酐(sCr)、尿肌酐(uCr)、尿鈉(uNa)和uNGAL.繪製uNGAL質量濃度隨時間變化麯線,Logistic迴歸分析首箇6h尿量、6h處uNa和6h處uNGAL與24 h內髮生AKI的關繫,計算受試者工作麯線(ROC)下麵積(AUC).結果 CLG組、HCG組和XBG組大鼠的uNGAL均于造模後6h內迅速升高,峰值分彆齣現于6h處(CLG組)、24 h處(HCG組和XBG組),後均快速下降;三組大鼠經同時間點uCr校正的uNGAL (cuNGAL)于造模後6h內迅速升高,峰值均齣現在24 h處.CLG組大鼠中髮生AKI與未髮生AKI大鼠的uNGAL或cuNGAL隨時間變化麯線幾近重疊,在各時間點的濃度差異無統計學意義(uNGAL:6 h,t=0.691; 12h,t=1.627; 18h,t=0.511. cuNGAL:6h,t=0.371; 12h,t =0.474; 18h,t=-1.187;均P＞0.05);XBG組uNGAL或cuNGAL隨時間變化麯線不重疊,各時間點的質量濃度差異無統計學意義(uNGAL:6 h,t=1.222;12 h,t=1.178;18 h,t=1.272; 24h,=0.918; 36 h,t=0.442. cuNGAL:6 h,t=1.482; 12h,t=1.314; 18h,t=1.280; 24h,t=0.280; 36h,=0.467.均P＞0.05).HCG組,髮生AKI大鼠的uNGAL隨時間變化麯線自6h後各箇時間點上升幅度明顯高于未髮生AKI大鼠(6h,t=2.351,P＜0.05;12 h,t=3.086,P＜0.01; 18h,t=2.535,P＜0.05;24h,t=2.150,P＜0.05;36 h,t=2.485,P＜0.05),6h、18 h和24h處髮生與未髮生AKI大鼠的cuNGAL均值間差異具有統計學意義(6h,t=3.013,P＜0.01; 18 h,t=4.804,P＜0.01; 24 h,t=2.682,P＜ 0.05).6h處Uout可提高cuNGAL對24h內髮生AKI預測能力(AUC由0.839提高至0.900,P＜0.05).結論 膿毒癥時施加的榦預措施會影響尿中NGAL的分泌量和分泌時序;uNGAL和cuNGAL是膿毒癥大鼠髮生AKI的良好預測因子.
목적 관찰농독증간예여부정황하뇨중성립세포명효매상관재지단백(uNGAL)질량농도변화특점병평개기대급성신손상(AKI)적진단개치.방법 56지SD(Sprague Dawley)대서수궤(수궤수자법)분위4조,모형조(CLG) 16지、혈필정조(XBG) 16지、황기주사액화시호주사액합용조(HCG) 16지급가수술조(SOG)8지.CLG조、HCG조화XBG조이맹장결찰천공술(CLP)제작농독증모형,조모후HCG조복강주사황기주사액화시호주사액;XBG조정맥주사혈필정주사액;SOG조지개복불행CLP.우술전(0 h)、술후6h、12h、18h、24 h、36 h、48 h화72 h류취혈청화뇨액,검측혈청기항(sCr)、뇨기항(uCr)、뇨납(uNa)화uNGAL.회제uNGAL질량농도수시간변화곡선,Logistic회귀분석수개6h뇨량、6h처uNa화6h처uNGAL여24 h내발생AKI적관계,계산수시자공작곡선(ROC)하면적(AUC).결과 CLG조、HCG조화XBG조대서적uNGAL균우조모후6h내신속승고,봉치분별출현우6h처(CLG조)、24 h처(HCG조화XBG조),후균쾌속하강;삼조대서경동시간점uCr교정적uNGAL (cuNGAL)우조모후6h내신속승고,봉치균출현재24 h처.CLG조대서중발생AKI여미발생AKI대서적uNGAL혹cuNGAL수시간변화곡선궤근중첩,재각시간점적농도차이무통계학의의(uNGAL:6 h,t=0.691; 12h,t=1.627; 18h,t=0.511. cuNGAL:6h,t=0.371; 12h,t =0.474; 18h,t=-1.187;균P＞0.05);XBG조uNGAL혹cuNGAL수시간변화곡선불중첩,각시간점적질량농도차이무통계학의의(uNGAL:6 h,t=1.222;12 h,t=1.178;18 h,t=1.272; 24h,=0.918; 36 h,t=0.442. cuNGAL:6 h,t=1.482; 12h,t=1.314; 18h,t=1.280; 24h,t=0.280; 36h,=0.467.균P＞0.05).HCG조,발생AKI대서적uNGAL수시간변화곡선자6h후각개시간점상승폭도명현고우미발생AKI대서(6h,t=2.351,P＜0.05;12 h,t=3.086,P＜0.01; 18h,t=2.535,P＜0.05;24h,t=2.150,P＜0.05;36 h,t=2.485,P＜0.05),6h、18 h화24h처발생여미발생AKI대서적cuNGAL균치간차이구유통계학의의(6h,t=3.013,P＜0.01; 18 h,t=4.804,P＜0.01; 24 h,t=2.682,P＜ 0.05).6h처Uout가제고cuNGAL대24h내발생AKI예측능력(AUC유0.839제고지0.900,P＜0.05).결론 농독증시시가적간예조시회영향뇨중NGAL적분비량화분비시서;uNGAL화cuNGAL시농독증대서발생AKI적량호예측인자.
Objective ①Observing urinary neutrophil gelatinase-associated lipocalin (uNGAL)'s concentration variation under the intervention of sepsis; ②Evaluatingu NGAL' s diagnostic value for early acute kidney injury (AKI).Method Fifty-six SD (Sprague Dawley) rats were randomly (random number) divided into four groups,including 16 rats in model group (CLG),16 rats in Xuebijing group (XBG),16 rats in Huangqi and Chaihu injection jointly applied group (HCG),and 8 rats in sham operation group (SOG).The septic models in CLG group,HCG group and XBG group were established by cecal ligation and puncture (CLP).Then,the rats in HCG group was treated with intraperitoneal injectionby Huangqi and Chaihu injections; the XBG group was treated with intravenous injection by Xuebijing injection; the SOG group was treated with open surgery without CLP.After the CLP,serial urine and serum samples were obtained at baseline (just prior to operation),6 h,12 h,18 h,24 h,36 h,48 h,and 72 h,and were measured by sCr,uCr,uNa,and uNGAL.The line graph of uNGAL' s concentration variation was plotted,based on the time.Diagnostic characteristics of urinary NGAL in predicting AKI were assessed by calculating the area under the receiver operating characteristic curve (AUC).Results After the CLP,the uNGAL of sepsis model rats increased quickly within 6 hours.The time points of each group model reaching their peak were 6 hours after CLP in CLG groupand 24 hours after CLP in HCG group and XBG group.These groups' uNGAL all decreased quickly after the peak.The cuNGAL of sepsis model rats was increased quickly within 6 hours after CLP,reached its peak at 24 hours after CLP.In CLG group,the line graphs of uNGAL or cuNGAL were almost overlapped.There is little difference in the concentration of uNGAL or cuNGAL at each time point (uNGAL:6h,t=0.691; 12h,t=1.627; 18 h,t=0.511,cuNGAL:6h,t =0.371 ; 12 h,t =0.474; 18 h,t =-1.187.Statistical significance of all above value was P ＞0.05).InXBG group,the line graph of uNGAL and cuNGAL were not overlapped,but difference between uNGAL and cuNGAL concentration at each time point was not significant (uNGAL:6 h,t =1.222 ; 12 h,t =1.178 ; 18h,t=1.272; 24h,t=0.918; 36h,t =0.442.cuNGAL:6 h,t =1.482; 12 h,t =1.314; 18 h,t=1.280; 24 h,t =0.280; 36 h,t =0.467.Statistical significance of all above value was P ＞ 0.05).In HCG group,uNGAL of AKI rats were higher than non-AKI rats at each time points since 6 hours later (6 h,t =2.351,P＜0.05; 12h,t=3.086,P＜0.01; 18h,t=2.535,P＜0.05;24h,t=2.150,P＜0.05;36h,t =2.485,P ＜ 0.05),The average cuNGAL of AKI rats and non-AKI rats have statistical significance at 6h,18 h,and 24 h (6 h,t=3.013.P＜0.01; 18 h,t =4.804,P＜0.01; 24 h,t=2.682,P＜0.05).At 6 h,Uout can increase cuNGAL' s ability of predicting AKI' s occurrence in 24 hours (AUC increased from 0.839 to 0.900,P ＜ 0.05).Conclusions The intervention to the sepsis rats have influence on the secretion volume and secretion sequence of NGAL in rat urine.uNGAL and cuNGAL are good predictor of AKI occurrence in sepsis rats.
