越南ICU患者入院时尿中性粒细胞明胶酶相关脂蛋白测定预测急性肾损伤的恢复

L. V. Thang, N. Kien, P. N. H. Tuan, Nguyen Tien Dung, T. Q. Kien, D. M. Ha, P. Q. Toan, Nguyen T. T. Ha, D. T. Van, Nguyen Van Duc, Vu Xuan Nghia, N. H. Dung, N. Huong, H. T. Vinh, L. T. Ha
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摘要

目的:评价急性肾损伤(AKI)术后90天康复入院时尿中性粒细胞明胶酶相关脂钙蛋白(NGAL)的预测价值。本研究纳入101例入住重症监护室(ICU)诊断为AKI的成年患者(96例24小时尿液采集,5例无尿)。使用急性肾损伤网络(AKIN)标准诊断急性肾损伤。入院时使用BioVendor Human Lipocalin-2/NGAL ELISA检测尿液NGAL。90天后患者完全康复的比例为71.9%。恢复组尿NGAL浓度平均值为242.04 ng/ml,显著低于未恢复组(371.1 ng/ml), p=0.007。在截断值为740.03 ng/ml时,入院时测尿NGAL预测完全恢复,尿NGAL的ROC曲线下面积= 0.888,p<0.001。多因素回归分析显示,血清尿素、血清肌酐和尿NGAL是影响AKI患者康复比例的独立因素(OR=0.856, p=0.023;OR=1.014, p=0.012, OR=0.993, p<0.001)。血清尿素、血清肌酐和尿NGAL是影响AKI患者康复比例的独立因素。AKI患者在ICU入院时尿液NGAL可作为预后恢复的生物标志物。
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Urine Neutrophil Gelatinase-Associated Lipocalin Measured at Admission to Predict Recovery from Acute Kidney Injury of Vietnamese ICU Patients
To evaluate the predictive value of urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at the time of admission during the recovery from Acute Kidney Injury (AKI) after 90 days. This study includes 101 adult patients admitted to the Intensive Care Unit (ICU) who were diagnosed as AKI (96 patients had been collected 24-hour urine and 5 patients with anuria). Acute kidney injury was diagnosed using the Acute Kidney Injury Network (AKIN) criteria. Urine NGAL was measured at admission using the BioVendor Human Lipocalin-2/NGAL ELISA. The ratio of complete recovery patients after 90 days reached 71.9%. The mean of urine NGAL concentration in the recovery group was 242.04 ng/ml, lower significantly than that of non-recovery patients (371.1 ng/ml), p=0.007. At the cut-off value for 740.03 ng/ml, urine NGAL measured at admission predicted complete recovery with the area under the curve of ROC for urine NGAL = 0.888, p<0.001. Based on the multivariate regression analysis, serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients (OR=0.856, p=0.023; OR=1.014, p=0.012 and OR=0.993, p<0.001, respectively). Serum urea, serum creatinine and urine NGAL were independent factors that effected the proportion of recovery in AKI patients. Urine NGAL in AKI patients measured at the time of the admission time to ICU can be used as a prognostic biomarker of recovery.
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