尿NGAL和血清Cys C在百草枯中毒患者急性早期肾损伤中的变化及意义

检验医学 ›› 2012, Vol. 27 ›› Issue (11): 940-943.

尿NGAL和血清Cys C在百草枯中毒患者急性早期肾损伤中的变化及意义

1. 新乡医学院第一附属医院检验科，河南卫辉 453100；2. 新乡医学院医学检验系，河南新乡 453003

出版日期:2012-11-30 发布日期:2012-11-14
作者简介:张群妹，女，1981年生，技师，主要从事临床生化检验工作。

Change and significance on urinary NGAL and serum Cys C in paraquat poisoning patients with early kidney injury

1.Department of Clinical Laboratory，the First Affiliated Hospital of Xinxiang Medical College，Henan Weihui 453100，China；2.Department of Laboratory Medicine，Xinxiang Medical College，Henan Xinxiang 453003，China

Online:2012-11-30 Published:2012-11-14

摘要/Abstract

摘要： 目的　探讨尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和血清半胱氨酸蛋白酶抑制剂C（Cys C）在百草枯中毒患者急性肾损伤（AKI）早期的变化及意义。方法　收集85例百草枯中毒患者入院后即刻（15 min内）、2、4、6、8、10、12、18、24、36、48、72 h及5、7 d时的血液、尿液标本，根据是否发生AKI分为AKI组（62例）及无AKI组（23例）。同时以20名健康体检者作为正常对照组。用酶联免疫吸附试验（ELISA）检测尿NGAL水平；用肌氨酸氧化酶法测定血清肌酐（SCr）水平；用免疫透射比浊法测定血清Cys C水平。以各项目入院即刻检测值作为基线值。结果　85例百草枯中毒患者中有62例发生AKI，发生率为72.94％。AKI组SCr水平自入院18 h 开始明显升高，各时间点的检测值均高于基线值和正常对照组（P<0.01）。AKI组入院24、36、48、72 h及5、7 d的SCr水平明显高于无AKI组（P<0.01）。无AKI组各时间点的SCr水平与正常对照组比较差异均无统计学意义（P>0.05）。AKI组血清Cys C水平在入院6 h时已明显高于基线值（P<0.01）；以后各时间点呈逐渐升高趋势，均高于正常对照组和基线值（P<0.01）。无AKI组血清Cys C水平自入院10 h时开始明显升高，与正常对照组和基线值比较，差异有统计学意义（P<0.01）。AKI组尿NGAL水平在入院2 h时已明显高于基线值，以后各时间点呈逐渐升高趋势，与正常对照组和基线值比较，差异均有统计学意义（P<0.01）。无AKI组尿NGAL水平入院10h开始逐渐升高，与正常对照组和基线值比较，差异有统计学意义（P<0.01）。AKI组各时间点尿NGAL水平均明显高于无AKI组（P<0.01）。结论　百草枯中毒后2 h尿NGAL水平即可明显升高，血清Cys C于8 h开始升高，其诊断AKI的时间早于SCr。尿NGAL和血清Cys C可作为百草枯中毒后诊断AKI的早期标志物。

Abstract: Objective　To investigate the change and significance on urinary neutrophil gelatinase-associated lipocalin（NGAL）and serum cystatin C（Cys C）in paraquat poisoning patients with early acute kidney injury（AKI）. Methods　The blood and urine specimens from 85 patients with paraquat poisoning were collected immediately after admission（≤15 min），2，4，6，8，10，12，18，24，36，48，72 h and 5，7 d.According to the occurrence of AKI，they were classified into AKI group（62 cases）and non-AKI group（23 cases）.A total of 20 healthy subjects were enrolled as control group.The urinary NGAL level was determined by enzyme-linked immunosorbent assay（ELISA）. The serum creatinine（SCr）levels were determined by sarcosine oxidase method. The serum Cys C levels were determined by immuno turbidimetry. The admission immediate detection values were as the baseline values. Results　In 85 patients with paraquat poisoning，62 patients had AKI（72.94%）. In AKI group at each time point since the beginning of 18h，the SCr levels increased significantly，which were significantly higher than the baseline values and those in the control group（P<0.01）.In AKI group，24，36，48，72 h and 5，7 d SCr levels were significantly higher than those in non-AKI group（P<0.01）.In non-AKI group at each time point，SCr levels had no statistical significance with those in the control group（P>0.05）.Serum Cys C levels in AKI group at 6h were significantly higher than the baseline values（P<0.01）.After the time point，the levels increased gradually and were higher than those in the control group and the baseline values（P<0.01）.In non-AKI group，serum Cys C levels since the beginning of 10h increased significantly，and had a significant difference compared with those in the normal control group and the baseline values（P<0.01）. In AKI group，NGAL levels at 2h were significantly higher than the baseline values，and had gradual rising trend after that time point. Compared with those in the control group and the baseline values，the differences were statistically significant（P<0.01）.In non-AKI group，NGAL levels at 10h began gradually increased，and compared with those in the control group and the baseline values，the difference was statistically significant（P<0.01）.In AKI group，NGAL levels at each time point were obviously higher than those in non-AKI group（P<0.01）. Conclusions　With paraquat poisoning after 2 h，urinary NGAL level is markedly elevated，and serum Cys C in 8h begins to increase.The diagnosis time of AKI is shorter than that of SCr. Urinary NGAL and serum Cys C can be markers for the early diagnosis of AKI after paraquat poisoning.

Key words: Neutrophil gelatinase-associated lipocalin, Cystatin C, Paraquat, Acute kidney injury

张群妹1，郭庆合2，鲁广建1，宋志善2. 尿NGAL和血清Cys C在百草枯中毒患者急性早期肾损伤中的变化及意义[J]. 检验医学, 2012, 27(11): 940-943.

ZHANG Qunmei1，GUO Qinghe2，LU Guangjian1，SONG Zhishan2. Change and significance on urinary NGAL and serum Cys C in paraquat poisoning patients with early kidney injury[J]. , 2012, 27(11): 940-943.