肝硬化并发肝肾综合征患者U-mAl及外周血NLR和血清NGAL水平变化研究*

doi:10.3969/j.issn.1672-5069.2023.06.023

摘要/Abstract

摘要： 目的探讨肝硬化并发肝肾综合征(HRS)患者尿微量白蛋白(U-mAl)及外周血中性粒细胞/淋巴细胞比值(NLR)和血清中性粒细胞明胶酶相关载脂蛋白(NGAL)水平变化及其临床意义。方法 2020年1月～2022年1月我院收治的肝硬化并发HRS患者43例和失代偿期肝硬化患者43例,使用全自动特定蛋白分析仪测定尿U-mAl水平,使用全自动血细胞分析仪检测外周血淋巴细胞计数和中性粒细胞计数,并计算NLR。采用ELISA法检测血清NGAL水平。采用Pearson相关性分析,应用受试者工作特征(ROC)曲线评价U-mAl、NLR和NGAL单独或联合诊断肝硬化并发HRS的效能。结果肝硬化并发HRS患者尿U-mAl、NLR和血清NGAL水平分别为(25.7±5.3)mg/24 h、(3.8±0.8)和(31.8±6.5) ng/mL,显著高于肝硬化患者【分别为(18.9±3.4)mg/24 h、(3.1±0.6)和(26.1±4.8) ng/mL,P＜0.05】;肝硬化并发HRS患者U-mAl水平与NLR或NGAL水平呈正相关(r=0.470、r=0.476,均P<0.001),NLR水平与NGAL水平呈正相关(r=0.752,P<0.001);分别以U-mAl=25.0 mg/24 h、NLR=3.5和NGAL=29.2 ng/mL为截断点,它们单独诊断HRS的AUC分别为0.741、0.733和0.734,差异均无统计学意义(P＞0.05),采用U-mAl、NLR和NGAL联合诊断HRS的AUC为0.870,其敏感度为0.973,特异度为0.767,联合诊断的AUC显著大于各指标的单独检测(Z=3.047、Z=3.039、Z=2.806,P=0.002、P=0.002、P=0.005)。结论采用尿U-mAl及外周血NLR和血清NGAL联合检测诊断肝硬化并发HRS具有简单、实用、可行的特点,值得临床验证。

关键词: 肝硬化, 肝肾综合征, 尿微量白蛋白, 中性粒细胞/淋巴细胞比值, 中性粒细胞明胶酶相关载脂蛋白, 诊断

Abstract: Objective The aim of this study was to explore the changes and clinical implications of urine microalbumin (U-mAl), peripheral blood neutrophil/lymphocyte ratio (NLR) and serum neutrophil gelatinase-associated lipocalin (NGAL) level in patients with cirrhosis and complicated hepatorenal syndrome (HRS). Methods 43 patients with cirrhosis and complicated HRS, and 43 patients with decompensated cirrhosis were admitted to our hospital between January 2020 and January 2022, and urine U-mAl level was detected by full-automatic specific protein analyzer. The peripheral blood lymphocyte count and neutrophil count were detected by full-automatic blood cell analyzer, and NLR was calculated. Serum NGAL level was detected by ELISA. The correlation was analyzed by Pearson’ and the diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curves. Results Urine U-mAl level, the NLR and serum NGAL level in patients with cirrhosis and HRS were(25.7±5.3)mg/24 h,(3.8±0.8) and (31.8±6.5) ng/mL, significantly higher than [(18.9±3.4)mg/24 h, (3.1±0.6) and (26.1±4.8) ng/mL, respectively, P＜0.05] in patients with decompensated cirrhosis; urine U-mAl level was positively correlated to NLR or serum NGAL level (r=0.470, r=0.476, both P<0.001), and the NLR was also positively correlated to serum NGAL level (r=0.752, P<0.001) in patients with cirrhosis and HRS; the AUCs were 0.741, 0.733 and 0.734 (P＞0.05), as urine U-mAl equal to 25.0 mg/24 h, the NLR equal to 3.5 and serum NGAL level equal to 29.2 ng/mL were set as the cut-off-value, in predicting HRS in patients with cirrhosis, while the AUC was 0.870, with the sensitivity of 0.973 and the specificity of 0.767 when the three parameters was combined to predict (Z=3.047, Z=3.039, and Z=2.806, all P<0.01). Conclusion The detection of urine U-mAl level, peripheral blood NLR and serum NGAL level might be an easy way to predict the occurrence of HRS in patients decompensated liver cirrhosis, and worthy of further investigation.

Key words: Liver cirrhosis, Hepatorenal syndrome, Microalbumin, Neutrophil/lymphocyte ratio, Neutrophil gelatinase-associated lipocalin, Diagnosis

田宇, 陈燕, 曹佳非, 周晓倩. 肝硬化并发肝肾综合征患者U-mAl及外周血NLR和血清NGAL水平变化研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 859-862.

Tian Yu, Chen Yan, Cao Jiafei, et al. Changes of urine U-mAl, peripheral blood NLR and serum NGAL level in patients with cirrhosis and complicated hepatorenal syndrome[J]. Journal of Practical Hepatology, 2023, 26(6): 859-862.

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肝硬化并发肝肾综合征患者U-mAl及外周血NLR和血清NGAL水平变化研究^*

Changes of urine U-mAl, peripheral blood NLR and serum NGAL level in patients with cirrhosis and complicated hepatorenal syndrome

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