NGAL在原发性高血压患者肾功能损伤诊断中的价值

doi:10.3969/j.issn.1673-8640.2019.05.002

摘要/Abstract

摘要：

目的探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）诊断原发性高血压患者肾功能损伤的价值。方法检测154例原发性高血压患者[1级高血压组（50例）、2级高血压组（47例）和3级高血压组（57例）]和50名体检健康者（正常对照组）血清NGAL、肌酐（Cr）和胱抑素C（Cys C）水平。采用受试者工作特征（ROC）曲线评价血清Cys C和NGAL诊断原发性高血压患者肾功能损伤的价值。采用Pearson相关分析评价各项目间的相关性。结果原发性高血压各组血清NGAL、Cr和Cys C水平均明显高于正常对照组（P<0.05）。2级高血压组和3级高血压组估算肾小球滤过率（eGFR）均低于正常对照组（P<0.05）。3级高血压组血清NGAL、Cr、Cys C水平明显高于2级高血压组和1级高血压组（P<0.05、P<0.001）。2级高血压组血清NGAL水平明显高于1级高血压组（P<0.001）。3级高血压组eGFR明显低于1级高血压组和2级高血压组（P<0.05）。血清Cr、Cys C与血清NGAL呈弱正相关（r值分别为0.314、0.333,P<0.001）,而血清Cr与血清Cys C呈正相关（r=0.789,P<0.001）。Cys C和NGAL联合检测诊断原发性高血压患者肾功能损伤的曲线下面积（AUC）为0.935,明显优于单项检测（0.910、0.874）;联合检测的阳性率（78.6%）高于单项检测的阳性率（51.2%、69.4%,P<0.001）。结论 NGAL对原发性高血压肾功能损伤的诊断具有重要价值。

Abstract:

Objective To investigate the role of neutrophil gelatinase-associated lipocalin （NGAL） for the diagnosis of kidney injury in patients with essential hypertension. Methods A total of 154 patients with essential hypertension [stage 1 group （50 cases）,stage 2 group （47 cases） and stage 3 group （57 cases）] and 50 healthy subjects （healthy control group） were determined for the levels of serum creatinine （Cr）,cystatin C（Cys C）and NGAL. Receiver operating characteristic （ROC） curve was used to evaluate the roles of Cys C and NGAL for the diagnosis of kidney injury in patients with essential hypertension. Pearson correlation analysis was used to evaluate the correlations between variables. Results The levels of serum Cr,Cys C and NGAL in essential hypertension group were higher than those in healthy control group （P<0.05）. The estimated glomerular filtration rate（eGFR） in healthy control group was higher than those in stage 3 and 2 groups （P<0.05）. Serum NGAL,Cr and Cys C levels in stage 3 group were higher than those in stage 2 and 1 groups （P<0.05,P<0.001）. Serum NGAL level in stage 2 group was higher than that in stage 1 group （P<0.001）. The eGFR in stage 3 group was lower than those in stage 1 and 2 groups （P<0.05）. There was a strong positive correlation between serum Cr and Cys C（r=0.789,P<0.001）,but serum NGAL had a weak positive correlation with Cr（r=0.314,P<0.001）and Cys C（r=0.333,P<0.001）. The combined determination of Cys C and NGAL for the diagnosis of kidney injury in patients with essential hypertension had the area under curve（AUC） of 0.935,which was bigger than those of single determinations （that for NGAL was 0.874 and that for Cys C was 0.910）. The positive rate of combined determination （78.6%） was higher than those of Cys C and NGAL single determinations （51.2% and 69.4%,respectively,P<0.001）. Conclusions NGAL plays a role in the diagnosis of kidney injury for patients with essential hypertension.

Key words: Neutrophil gelatinase-associated lipocalin, Kidney injury, Essential hypertension

中图分类号:

R446.1

李波, 王海玉, 刘雅洁. NGAL在原发性高血压患者肾功能损伤诊断中的价值[J]. 检验医学, 2019, 34(5): 390-393.

LI Bo, WANG Haiyu, LIU Yajie. Role of NGAL for the diagnosis of kidney injury in patients with essential hypertension[J]. Laboratory Medicine, 2019, 34(5): 390-393.

图/表 2

参考文献 12

[1]	SCHIEβL I M,HAMMER A,KATTLER V,et al. Intravital imaging reveals angiotensin Ⅱ-induced transcytosis of albumin by podocytes[J]. J Am Soc Nephrol,2016,27(3):731-744.
[2]	LV L L,LIU B C.Role of non-classical renin-angiotensin system axis in renal fibrosis[J]. Front Physiol,2015,6:117.
[3]	KJELDSEN L,JOHNSEN A H,SENGELØV H,et al. Isolation and primary structure of NGAL,a novel protein associated with human neutrophil gelatinase[J]. J Biol Chem,1993,268(14):10425-10432.
[4]	中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华心血管杂志,2011,39(7):579-616.
[5]	MICELI A,BRUNO V D,CAPOUN R,et al.Occult renal dysfunction:a mortality and morbidity risk factor in coronary artery bypass grafting surgery[J]. J Thorac Cardiovasc Surg,2011,141(3):771-776.
[6]	BOLIGNANO D,COPPOLINO G,LACQUANITI A,et al.Pathological and prognostic value of urinary neutrophil gelatinase-associated lipocalin in macroproteinuric patients with worsening renal function[J]. Kidney Blood Press Res,2008,31(4):274-279.
[7]	MALYSZKO J,BACHORZEWSKA-GAJEWSKA H,MALYSZKO J S,et al.Serum neutrophil gelatinase- associated lipocalin as a marker of renal function in hypertensive and normotensive patients with coronary artery disease[J]. Nephrology (Carlton),2008,13(2):153-156.
[8]	赵玉军. 原发性高血压患者尿NGAL水平检测对肾功能损害的早期诊断价值[J]. 山东医药,2017,57(17):67-69.
[9]	LEONCINI G,VIAZZI F,CONTI N,et al.Renal and cardiac abnormalities in primary hypertension[J]. J Hypertens,2009,27(5):1064-1073.
[10]	黄胜贤,覃海燕,黄丽英,等. Cys C、UA、β2-MG、CRP 在老年高血压患者早期肾损伤中的价值[J]. 检验医学,2016,31(8):728-729.
[11]	QUINTAVALLE C,ANSELMI C V,DE MICCO F,et al.Neutrophil gelatinase-associated lipocalin and contrast-induced acute kidney injury[J]. Circ Cardiovasc Interv,2015,8(9):e002673.
[12]	MALYSZKO J,BACHORZEWSKA-GAJEWSKA H,MALYSZKO J,et al.Markers of kidney function in the elderly in relation to the new CDK-EPI formula for estimation of glomerular filtration rate[J]. Arch Med Sci,2011,7(4):658-664.

组别	例数	Cr（μmol/L）	Cys C（mg/L）	NGAL（ng/mL）	eGFR[mL/（min·1.73 m²）]
正常对照组	50	61.00（52.00~73.00）	0.67 （0.64~0.76）	68.85 （54.15~89.25）	92.86 （81.75~103.96）
原发性高血压组
1级高血压组	50	69.45（59.62~81.87）^*	0.93 （0.81~1.08）^*	103.90（59.47~182.82）^*	89.72 （76.33~97.75）
2级高血压组	47	77.40（58.50~89.80）^*	1.05 （0.88~1.16）^*	195.90（148.80~254.10）^*#	84.14 （72.42~92.33）^*
3级高血压组	57	81.30（70.70~107.50）^*#△	1.14 （0.96~1.37）^*#△	233.00（168.85~333.45）^*#△	72.42 （52.04~89.87）^*#△

组别	例数	Cr（μmol/L）	Cys C（mg/L）	NGAL（ng/mL）	eGFR[mL/（min·1.73 m²）]
正常对照组	50	61.00（52.00~73.00）	0.67 （0.64~0.76）	68.85 （54.15~89.25）	92.86 （81.75~103.96）
原发性高血压组
1级高血压组	50	69.45（59.62~81.87）^*	0.93 （0.81~1.08）^*	103.90（59.47~182.82）^*	89.72 （76.33~97.75）
2级高血压组	47	77.40（58.50~89.80）^*	1.05 （0.88~1.16）^*	195.90（148.80~254.10）^*#	84.14 （72.42~92.33）^*
3级高血压组	57	81.30（70.70~107.50）^*#△	1.14 （0.96~1.37）^*#△	233.00（168.85~333.45）^*#△	72.42 （52.04~89.87）^*#△

[1]	戴健敏, 陈诺, 魏坚. 慢性肾脏病不同阶段患者血清ProGRP、NSE、CYFRA21-1水平的变化[J]. 检验医学, 2022, 37(9): 811-814.
[2]	范桃红, 宋志明, 安元元, 刘路阳, 董凤娟. 原发性高血压病患者运动血压与VCAM-1、sICAM-1和FMD的相关性[J]. 检验医学, 2021, 36(4): 404-407.
[3]	朱庆华, 王伟伟, 邹广慧, 董志武. 血清NGAL和Cys C联合检测在诊断2型糖尿病早期肾损伤中的价值[J]. 检验医学, 2021, 36(3): 281-284.
[4]	徐文俊, 李甲勇, 李会丹. 不同eGFR公式与ACR联合应用在肾功能损伤高危人群中的临床价值[J]. 检验医学, 2021, 36(1): 13-19.
[5]	葛玲, 吴丽颖. 中性粒细胞明胶酶相关脂质运载蛋白在急性胰腺炎中的应用[J]. 检验医学, 2020, 35(5): 420-423.
[6]	田晓怡, 沈颖, 宋文琪. 儿童急性肾损伤相关新型生物标志物的研究进展[J]. 检验医学, 2018, 33(9): 850-856.
[7]	钱成荣, 田雪梅, 侯学伶, 刘昱, 李晗, 银广悦. 红细胞分布宽度和中性粒细胞/淋巴细胞比值与原发性高血压分层的相关性[J]. 检验医学, 2017, 32(10): 886-889.
[8]	孙丽, 牛国平. 胶乳增强免疫比浊法定量测定血浆中性粒细胞明胶酶相关脂质运载蛋白的方法学评价及临床应用[J]. 检验医学, 2015, 30(7): 734-739.
[9]	张科, 刘彧崟, 张春, 张德太. 尿NGAL与CKD肾小管间质损伤的相关性研究[J]. 检验医学, 2015, 30(4): 327-330.
[10]	杨文东. 原发性高血压患者血清铁蛋白和同型半胱氨酸水平与颈动脉粥样硬化的相关性研究[J]. 检验医学, 2015, 30(3): 227-229.
[11]	刘静, 李宾, 刘姝莉, 郑曦. 原发性高血压患者RDW-CV水平变化及与左心室质量指数的相关性研究[J]. 检验医学, 2015, 30(10): 998-1001.
[12]	张雅丽, 崔丽艳, 张捷. 中性粒细胞明胶酶相关脂质运载蛋白在急性肾损伤中的保护作用[J]. 检验医学, 2015, 30(1): 80-84.
[13]	朱安友,王凤超,陈卫东,胡建国. 肾功能损伤及血液透析患者血清胃蛋白酶原浓度的变化[J]. 检验医学, 2014, 29(6): 685-687.
[14]	徐磊, 徐晓萍, 应春妹. NGAL在成人心脏术后急性肾损伤中的早期应用价值探讨[J]. 检验医学, 2014, 29(2): 139-142.
[15]	徐佳音，徐锦. 中性粒细胞明胶酶相关脂质转运蛋白在小儿体外循环心脏术后急性肾功能损伤中的诊断价值[J]. 检验医学, 2014, 29(11): 1084-1088.