Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery
Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery
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DOI：
10.1016/s0140-6736(05)74811-x
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发表时间：
2005-04-02
期刊：
影响因子：
168.9
通讯作者：
Devarajan, P
中科院分区：
文献类型：
--
作者：
Mishra, J;Dent, C;Devarajan, P
急性肾功能衰竭早期生物标志物的缺乏阻碍了我们及时采取预防和治疗措施的能力。我们测试的假设，中性粒细胞明胶酶相关的脂质运载蛋白（NGAL）是一个早期的生物标志物缺血性肾损伤后，心肺byproducts.Methods我们研究了71例儿童接受心肺转流。通过蛋白质印迹和ELISA分析系列尿液和血液样品的NGAL表达。主要结局指标是急性肾损伤，定义为血清肌酐从baseline.Findings增加50%，20名儿童（28%）发展为急性肾损伤，但诊断与血清肌酐仅可能在体外循环后1-3天。相比之下，尿液中NGAL浓度从基线时的平均1-6 μ g/L（SE 0.3）上升到心肺转流术后2小时的147 μ g/L（23），血清中NGAL含量从基线时的平均3.2 μ g/L（SE 0.5）上升到术后2小时的61 μ g/L（10）。单因素分析显示，急性肾损伤与以下因素显著相关：2 h时尿和血清NGAL浓度以及体外循环时间。通过多因素分析，体外循环后2 h尿NGAL的量是急性肾损伤最有力的独立预测因子。对于2小时时尿中NGAL浓度，接受者工作特征曲线下的面积为0-998，灵敏度为1.00，特异性为0.98，截止值为50 μ g/L。解释尿和血清中NGAL浓度代表心脏手术后急性肾损伤的灵敏、特异和高度预测性早期生物标志物。
Background The scarcity of early biomarkers for acute renal failure has hindered our ability to launch preventive and therapeutic measures for this disorder in a timely manner. We tested the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker for ischaemic renal injury after cardiopulmonary bypass.Methods We studied 71 children undergoing cardiopulmonary bypass. Serial urine and blood samples were analysed by western blots and ELISA for NGAL expression. The primary outcome measure was acute renal injury, defined as a 50% increase in serum creatinine from baseline.Findings 20 children (28%) developed acute renal injury, but diagnosis with serum creatinine was only possible 1-3 days after cardiopulmonary bypass. By contrast, urine concentrations of NGAL rose from a mean of 1-6 mu g/L (SE 0.3) at baseline to 147 mu g/L (23) 2 h after cardiopulmonary bypass, and the amount in serum increased from a mean of 3.2 mu g/L (SE 0.5) at baseline to 61 mu g/L (10) 2 h after the procedure. Univariate analysis showed a significant correlation between acute renal injury and the following: urine and serum concentrations of NGAL at 2 h, and cardiopulmonary bypass time. By multivariate analysis, the amount of NGAL in urine at 2 h after cardiopulmonary bypass was the most powerful independent predictor of acute renal injury. For concentration in urine of NGAL at 2 h, the area under the receiver-operating characteristic curve was 0-998, sensitivity was 1.00, and specificity was 0.98 for a cutoff value of 50 mu g/L.Interpretation Concentrations in urine and serum of NGAL represent sensitive, specific, and highly predictive early biomarkers for acute renal injury after cardiac surgery.