CAJ | 학술논문

目的：探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）在不同分期慢性肾病（CKD）中的临床价值。方法选取2012年5月至2013年12月解放军总医院明确诊断为 CKD的患者240例，按照美国肾脏病与透析患者生存质量指导指南（K／DOQI）制订的 CKD分期标准分为6组，即 CKD 1期组、CKD 2期组、CKD 3a期组、CKD 3b期组、CKD 4期组、CKD 5期组，应用胶乳增强免疫比浊法测定血液 NGAL （sNGAL ）浓度，对sNGAL在CKD中的应用价值进行横断面研究。结果在CKD各分期中，随着病变程度的增加，eGFR的减少，sNGAL浓度呈明显升高趋势（P＜0．01）。sNGAL与 eGFR呈明显负相关（P＜0．05）。sNGAL浓度在CKD 3b期组明显高于CKD 3a期组（P＜0．05）。在ROC曲线分析中，诊断肾功能轻中度损伤时，血清标本 sNGAL同 CysC、sβ2‐MG曲线下面积相似（0．903、0．945、0．937），在诊断肾功能轻度损伤中，血清sNGAL、CysC、sβ2‐MG水平ROC曲线下面积相似（0．819、0．899、0．900）。sNGAL在CKD 3～5期的临床诊断界值为CKD 3a期189．5 g／L、CKD 3b期222．0 g／L、CKD 4期259．0 g／L、CKD 5期317．5 g／L。结论 NGAL对CKD患者的肾损伤程度有一定的诊断价值。
목적：탐토중성립세포명효매상관지질운재단백（NGAL）재불동분기만성신병（CKD）중적림상개치。방법선취2012년5월지2013년12월해방군총의원명학진단위 CKD적환자240례，안조미국신장병여투석환자생존질량지도지남（K／DOQI）제정적 CKD분기표준분위6조，즉 CKD 1기조、CKD 2기조、CKD 3a기조、CKD 3b기조、CKD 4기조、CKD 5기조，응용효유증강면역비탁법측정혈액 NGAL （sNGAL ）농도，대sNGAL재CKD중적응용개치진행횡단면연구。결과재CKD각분기중，수착병변정도적증가，eGFR적감소，sNGAL농도정명현승고추세（P＜0．01）。sNGAL여 eGFR정명현부상관（P＜0．05）。sNGAL농도재CKD 3b기조명현고우CKD 3a기조（P＜0．05）。재ROC곡선분석중，진단신공능경중도손상시，혈청표본 sNGAL동 CysC、sβ2‐MG곡선하면적상사（0．903、0．945、0．937），재진단신공능경도손상중，혈청sNGAL、CysC、sβ2‐MG수평ROC곡선하면적상사（0．819、0．899、0．900）。sNGAL재CKD 3～5기적림상진단계치위CKD 3a기189．5 g／L、CKD 3b기222．0 g／L、CKD 4기259．0 g／L、CKD 5기317．5 g／L。결론 NGAL대CKD환자적신손상정도유일정적진단개치。
Objective To explore the clinical value of the neutrophil gelatinase‐associated lipocalin(NGAL) in different stages of chronic kidney disease(CKD) .Methods According to the criteria of CKD stage formulated by KDOQI/KDIGO ,240 patients with CKD in our hospital from May 2012 to December 2013 were divided into 6 groups including the CKD stage 1 ,2 ,3a ,3b ,4 and 5 .The serum NGAL level was tested by the latex‐enhanced immunoturbi‐dimetric assay .The application value of sNGAL in CKD was performed the cross‐sectional study .Results The NGAL level showed the significantly increasing trend with the increase of the CKD severity and the decline of the eG‐FR(P<0 .01) .The sNGAL level was negatively correlated with eGFR(P<0 .05) .The sNGAL level in the CKD 3b stage group was significantly higher than that in the CKD 3a stage group(P<0 .05) .In the ROC curve analysis ,for diagnosing mild and moderate renal function impairment ,serum sample sNGAL was similar to the areas under curve (AUC) of CysC and sβ2‐MG(0 .903 ,0 .945 ,0 .937) ,for diagnosing mild renal function impairment ,serum sNGAL , CysC and sβ2‐MG levels had similar AUC of ROC curve(0 .819 ,0 .899 ,0 .900) .The clinical diagnostic values of sN‐GAL were 189 .5 g/L for CKD 3a stage ,222 .0 g/L for CKD 3b stage ,259 .0 g/L for CKD 4 stage and 317 .5 g/L for CKD 5 stage .Conclusion NGAL has certain diagnostic value for the renal function impairment degree of CKD .