关键词: 肝硬化, 急性肾损伤, 中性粒细胞明胶酶原相关蛋白, 胰岛素样生长因子结合蛋白7, 金属蛋白酶组织抑制剂-2

Abstract: Objective The aim of this study was to explore the clinical implications of serum and urine neutrophil gelatinase-associated lipocalin (NGAL), insulin-like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) levels in patients with hepatitis B liver cirrhosis (LC) complicated with acute kidney injury (AKI) . Methods 119 patients with hepatitis B-induced LC (complicated with AKI in 38 cases, including stage 1 in 15 cases, stage 2 in 14 cases and stage 3 in 9 cases), and 54 healthy individuals at physical examination were enrolled in our hospital between March 2020 and December 2022. Serum NGAL as well as urine NGAL, IGFBP7 and TIMP-2 levels were detected by ELISA. The univariate and multivariate Logistic regression analysis were applied to assess the risk factors for the occurrence of AKI in patients with decompensated LC. Results Serum NGAL, urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI were (371.7±60.2)μg/L, (59.7±7.3)μg/L, (3.3±0.6)ng/mL and (98.3±19.5)ng/mL, all significantly higher than [(82.3±15.7)μg/L, (10.7±2.5)μg/L, (2.4±0.5)ng/mL and (85.0±18.2)ng/mL, respectively, P<0.05] in patients with LC or [(46.5±10.9)μg/L, (7.9±1.2)μg/L,(0.7±0.1)ng/mL and (16.1±3.7)ng/mL, respectively, P<0.05] in healthy control; serum NGAL, urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI stage 3 were (552.7±63.5)μg/L, (81.9±13.7)μg/L, (4.0±0.7)ng/mL and (110.4±15.1)ng/mL, all significantly higher than [(249.5±50.7)μg/L, (45.7±11.9)μg/L, (2.8±0.6)ng/mL and (90.3±10.9)ng/mL, P<0.05] in patients with AKI stage 1 or [(386.3±59.8)μg/L, (60.4±9.5)μg/L, (3.4±0.7)ng/mL and(99.1±12.7)ng/mL, P<0.05] in patients with AKI stage 2; the 90 d survival rate in our patients with AKI was 57.9%; the percentages of Child-Pugh class C, AKI stage 3, with hepatic encephalopathy (HE), infection and upper gastrointestinal bleeding (UGIB) in dead group were much higher than in survivals, and serum NGAL level and urine NGAL, TIMP-2 and IGFBP7 levels were also significantly higher than in survivals (P<0.05); the multivariate Logistic regression analysis showed that the Child-Pugh class C, AKI stage 3, HE, UGIB and increased urine NGAL and IGFBP7 levels were all the independent risk factors for poor prognosis in patients with AKI and underlying LC (P<0.05). Conclusion The changes of serum NGAL and urine NGAL, TIMP-2 and IGFBP7 levels in patients with AKI secondary to hepatitis B LC are related to the disease severity, and the increased urine NGAL and GFBP7 levels are risk factors for poor prognosis.

Key words: Liver cirrhosis, Acute kidney injury, Neutrophil gelatinase-associated lipocalin, Insulin-like growth factor binding protein 7, Tissue inhibitor of metalloproteinases-2