Objective: To explore the predictive value of urinary NGAL and KIM-1 in patients with hepatorenal syndrome with advanced cirrhosis. Methods: A total of 74 cases of advanced cirrhosis patients were selected as research object, all patients were followed up for 12 weeks. According to the HRS criteria, the patients were divided into two groups:cirrhosis group 53 cases and cirrhosis with HRS (HRS group) 21 cases, venous blood and urinary sample was collected on the 2nd day after admission, blood biochemical parameters, liver function and biochemical parameters were measured, the levels of serum CysC, NGAL, NAG, IL-18 and urine NGAL, IL-18, KIM-1, LFABP were detected by enzyme linked immunosorbent assay, the predictive value of urinary NGAL and KIM-1 in hepatorenal syndrome with advanced cirrhosis were performed by ROC curves. Results: The gender, age, serum creatinine, alanine aminotransferase, 24 h urinary protein excretion in cirrhosis group and HRS group had no significant difference (P>0.05), white blood cell count, platelet count, globulin, total bilirubin, aspartate aminotransferase, Child-Pugh score in HRS group was significantly higher than that in cirrhosis group, respectively; albumin in HRS group was significantly lower than that in cirrhosis group, the difference between the two groups was statistically significant (P<0.05). Serum NAG and IL-18 in cirrhosis group and HRS group was not significantly different (P>0.05), serum NGAL, CysC and urine NGAL, KIM-1, LFABP, IL-18 in HRS group were significantly higher than those in cirrhosis group, the difference between two groups was statistically significant (P<0.05). Multivariate analysis showed that urinary NGAL, KIM-1 and LFABP were independent risk factors for HRS (AllP<0.05). ROC curve analysis showed that the optimal critical value of NGAL was 18.83 μg·L-1, the area under the curve (AUC) was 0.913 (95%CI:0.851~0.975,P<0.05), the optimal critical value of KIM-1 was 1.72 μg·L-1, AUC was 0.957 (95%CI:0.918~0.996,P<0.05), the optimal critical value of LFABP was 5.02 μg·L-1, AUC was 0.702 (95%CI:0.593~0.811,P<0.05), the AUC of predictive value of urinary NGAL and KIM-1 was higher than that of urinary LFABP. Conclusion: Urinary NGAL and KIM-1 can be used as one of the predictors of HRS in patients with advanced cirrhosis. |
[1] MADDUKURI G,CAI C X,MUNIGALA S.et al.Targeting an early and substantial increase in mean arterial pressure is critical in the management of type 1 hepatorenal syndrome:A combined retrospective and pilot study[J].Dig Dis Sci,2014,59(2):471-481.
[2] BARBANO B,SARDO L,GIGANTE A,et al.Pathophysiology,diagnosis and clinical management of hepatorenal syndrome:From classic to new drugs[J].Curr Vasc Pharmacol,2014,12(1):125-135.
[3] PALAZZUOLI A,RUOCCO G,PELLEGRINI M,et al.Comparison of neutrophil gelatinase-associated lipocalin versus B-type natriuretic peptide and Cystatin C to predict early acute kidney injury and outcome in patients with acute heart failure[J].Am J Cardiol,2015,116(1):104-111.
[4] 蔡雷鸣,厉倩,金才峰,等.血清中性粒细胞明胶酶相关脂质运载蛋白检测在急性肾功能损伤早期诊断中的临床意义[J].检验医学,2012,27(4):287-290.
[5] 谷翠芝,李清初,曾凝,等.急性肾损伤患者NGAL、KIM -1与血肌酐的相关性[J].广东医学,2015,(20):3179-3181.
[6] STENVINKEL P,CARRERO JJ,AXELSSON J,et al.Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient:How do new pieces fit into the uremic puzzle[J].Clin J Am Soc Nephrol,2008,3(2):505-521.
[7] BIHL F,ALAEI M,NEGRO F.The new EASL guidelines for the management of chronic hepatitis B infection adapted for Swiss physicians[J].Swiss Med Wkly,2010,140(11-12):154-159.
[8] 杜虹,白雪帆.肝肾综合征的发病机制[J].临床内科杂志,2012,29(12):797-799.
[9] CHOLONGITAS E,SHUSANG V,MARELLI L,et al.Review article:renal function assessment in cirrhosis-difficulties and alternative measurements[J].Aliment Pharmacol Ther,2007,26(7):969-978.
[10] SEIBERT FS,PAGONAS N,ARNDT R,et al.Calprotectin and neutrophil gelatinase-associated lipocalin in the differentiation of pre-renal and intrinsic acute kidney injury[J].Acta Physiol (Oxf),2013,207(4):700-708.
[11] Kwon SH,Park MY,Jeon JS,et al.KIM-1 expression predicts renal outcomes in IgA nephropathy[J].Clin Exp Nephrol,2013,17(3):359-364.
[12] RHEE A C,CAIN A L,HILE K L,et al.IL-18 activation is dependent on Toll-like receptor 4 during renal obstruction[J].J Surg Res,2013,183(1):278-284.
[13] NIELSEN S E,ROSSING K,HESS G,et al.The effect of RAAS blockade on markers of renal tubular damage in diabetic nephropathy:U-NGAL,u-KIM1 and u-LFABP[J].Scand J Clin Lab Invest,2012,72(2):137-142.
[14] PARVEX P,COMBESCURE C,RODRIGUEZ M,et al.Is Cystatin C a promising marker of renal function,at birth,in neonates prenatally diagnosed with congenital kidney anomalies?[J].Nephrol Dial Transplant,2012,27(9):3477-3482.
[15] PARVEX P,COMBESCURE C,RODRIGUEZ M,et al.Evaluation and predictive factors of renal function progression using cystatin C and creatinine in neonates born with CAKUT[J].Clin Nephrol,2014,81(5):338-344.
[16] 赵珊,孙婷婷,李羽佳,等.系统性红斑狼疮患者尿N-乙酰-β-氨基葡萄糖苷酶水平及其临床意义的研究[J].中国医科大学学报,2013,42(1):35-37.
[17] GLUHOVSCHI C,VELCIOV S,KAYCSA A,et al.The dynamics of urinary N-acetyl-β-d-glucosaminidase (NAG),a marker of renal tubular dysfunction,in patients with lupus nephritis undergoing oral prednisone therapy[J].Immunopharmacol Immunotoxicol.2012,34(1):163-169.
[18] DIDZIAPETRIENE J,KAZBARIENE B,SURINENAITE B,et al.Antioxidative system parameters and level of IL-18 after surgery in patients with renal cell carcinoma according to gender[J].Acta Physiol Hung,2013,100(1):107-114.
[19] 邹广美,牛永胜,王慧,等.NGAL、IL-18及KIM-1在冠状动脉搭桥术后早期诊断急性肾损伤的意义[J].重庆医学,2013,(33):3986-3988.
[20] 申俊,刘妍,张金晓,等.尿中肾损伤分子1水平升高对大鼠早期肾损伤的预测作用[J].中国药理学与毒理学杂志,2012,26(2):212-218.
[21] 刘上,车妙琳,谢波,等.尿肝型脂肪酸结合蛋白及其与尿中性粒细胞明胶酶相关脂质运载蛋白联合应用在成人心脏手术后急性肾损伤诊断中的作用[J].中华肾脏病杂志,2012,28(5):361-366.
[22] VANMASSENHOVE J,VANHOLDER R,NAGLER E,et al.Urinary and serum biomarkers for the diagnosis of acute kidney injury:An in-depth review of the literature[J].Nephrol Dial Transplant,2013,28(2):254-273. |