血、尿NGAL在百草枯中毒急性肾损伤中的诊断价值

发布时间：2018-11-27 09:35

【摘要】：研究背景及目的百草枯(paraquat,PQ)是一种高效能的除草剂,是我国最常见的农药中毒类型,目前尚无特效对症解毒药物。急性肾损伤(acute kidney injury,AKI)是百草枯中毒的常见并发症之一,是预测百草枯中毒患者死亡的独立危险因素,百草枯中毒患者合并急性肾功能损伤时,死亡率高达66%。百草枯中毒患者急性肾功能损伤死亡率之所以居高不下,主要是缺乏早期、敏感诊断手段,未能及时的治疗,从而错过最佳的治疗时机。因此,早期及时发现百草枯中毒患者是否合并AKI,及时干预治疗,成为临床上提高存活率的一个关键因素。目前临床上主要以血肌酐和尿素作为诊断急性肾损伤的主要依据,但肌酐及尿素并不能早期及时反映肾脏功能损害。研究发现,中性粒细胞明胶蛋白酶相关性载脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)与急性肾脏功能损伤有较高的相关性,可能对急性肾功能损伤早期诊断、预防、治疗后预后改善等方面有重要意义,但在百草枯中毒急性肾损伤中的应用尚不明确,相关研究较少。本文的目的是探讨血、尿NGAL变化在百草枯中毒急性肾损伤中的诊断价值。研究方法收集2014年12月至2015年12月郑州大学第一附属医院急诊科收治的100例急性百草枯中毒患者,根据监测指标分百草枯中毒急性肾损伤组和非肾损伤组,记录患者入院第1天、第3天和第5天血及尿NGAL值,同时记录血肌酐、尿素动态变化水平。血肌酐、尿素、血NGAL、尿NGAL各时间段差异比较采用独立样本t检验进行分析。采用受试者工作曲线(ROC)分析检测各指标对急性百草枯中毒发生急性肾损伤的预测效果及敏感度和特异度,并确定血、尿NGAL的最佳诊断临界值。Spearman相关分析判断血、尿NGAL变化与百草枯中毒急性肾损伤有无相关性。结果本研究发现,百草枯中毒急性肾损伤组与非肾损伤组相比,第1天血NGAL、尿NGAL值在两组间差别有统计学意义(P0.05),而第1天血肌酐及尿素值在两组间则无显著性统计学差异(P0.05)。在第3天和第5天,血肌酐、尿素、血NGAL、尿NGAL在两组间差异均有统计学意义(P0.05)。ROC曲线分析发现,急性百草枯中毒早期(第1天)患者血NGAL、尿NGAL、血肌酐和尿素的AUC分别为0.85、0.89、0.73、0.64,早期血NGAL、尿NGAL的AUC值明显大于血肌酐及尿素,而在第3天时血NGAL、尿NGAL、血肌酐、尿素AUC分别是0.89、0.88、0.88、0.86,各曲线下面积无明显差异。在第5天时血NGAL、尿NGAL、血肌酐、尿素AUC分别是0.85、0.87、0.89、0.86,各曲线下面积差异不明显。Spearman相关性分析结果显示,早期血、尿NGAL变化与百草枯中毒急性肾损伤有明显的正相关(P0.05)。结论血、尿NGAL与百草枯中毒急性肾损伤密切相关,可以作为敏感的、可靠的百草枯中毒急性肾脏损伤的新型指标。
[Abstract]:Background and objective Paraquat (paraquat,PQ) is a highly effective herbicide and the most common type of pesticide poisoning in China. Acute renal injury (acute kidney injury,AKI) is one of the common complications of paraquat poisoning and an independent risk factor for predicting the death of paraquat poisoning patients. The mortality rate of paraquat poisoning patients with acute renal function injury is as high as 66%. The reason why the mortality rate of acute renal function injury in paraquat poisoning patients is high is the lack of early sensitive diagnostic means and the failure to treat in time so as to miss the best treatment opportunity. Therefore, early and timely detection of paraquat poisoning patients with AKI, intervention and treatment in time has become a key factor to improve the survival rate. At present, blood creatinine and urea are the main basis for the diagnosis of acute renal injury, but creatinine and urea can not reflect the renal function damage early and timely. It has been found that neutrophil gelatinase-associated apolipoprotein (neutrophil gelatinase associated lipocalin,NGAL) has a high correlation with acute renal function injury, and may be early diagnosis and prevention of acute renal function injury. It is important to improve the prognosis after treatment, but the application in acute renal injury caused by paraquat poisoning is not clear, and there are few related studies. The purpose of this paper is to investigate the diagnostic value of NGAL changes in blood and urine in acute renal injury caused by paraquat poisoning. Methods from December 2014 to December 2015, 100 patients with acute paraquat poisoning were collected from the emergency department of the first affiliated Hospital of Zhengzhou University. According to the monitoring indexes, they were divided into acute renal injury group and non-renal injury group. The NGAL values of blood and urine were recorded on the 1st, 3rd and 5th day after admission, and the dynamic changes of serum creatinine and urea were also recorded. The differences of serum creatinine, urea and NGAL, urine NGAL were analyzed by independent t test. The predictive effect, sensitivity and specificity of each index in predicting acute renal injury caused by acute paraquat poisoning were determined by (ROC) analysis of the operating curve of the subjects, and the best diagnostic critical value of NGAL in blood and urine was determined. Blood was judged by Spearman correlation analysis. There is no correlation between urinary NGAL and acute renal injury caused by paraquat poisoning. Results in this study, compared with non-renal injury group and paraquat poisoning acute renal injury group, there was a significant difference in serum NGAL, urine NGAL between the two groups on the first day (P0.05). On the first day, there was no significant difference in creatinine and urea between the two groups (P0.05). On the 3rd and 5th day, serum creatinine, urea and NGAL, urine NGAL were significantly different between the two groups (P0.05). ROC curve analysis showed that the early stage of acute paraquat poisoning (day 1) patients with serum NGAL, urine NGAL,) were significantly different between the two groups. The AUC of serum creatinine and urea were 0.85t 0.89U 0.73C 0.64, respectively. The AUC value of early NGAL, urine NGAL was significantly higher than that of serum creatinine and urea. On the 3rd day, the serum creatinine of serum NGAL, urine NGAL, and urea AUC were 0.8880.88 卤0.880.86, respectively. There was no significant difference in area under each curve. On the 5th day, the levels of serum creatinine and urea AUC in NGAL, urine NGAL, and urea AUC were 0.85-0.87 / 0.86, respectively, and there was no significant difference in the area under the curve. The results of Spearman correlation analysis showed that the early blood, the blood of early stage, had no significant difference between the two groups. Urinary NGAL was positively correlated with acute renal injury caused by paraquat poisoning (P0.05). Conclusion NGAL in blood and urine is closely related to acute renal injury caused by paraquat poisoning and can be used as a new sensitive and reliable marker for acute renal injury of paraquat poisoning.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.4
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本文编号：2360241