Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
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10.18869/acadpub.tumj
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jalali
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تعیین ارزش پیشبینی کننده بیومارکر لیپوکالین وابسته به ژلاتیناز نوتروفیل در تشخیص زودرس کنتراست نفروپاتی پس از آنژیوگرافی/ آنژیوپلاستی
The predictive value of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in early diagnosis of contrast-induced nephropathy upon angioplasthy/ angiography
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<p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و هدف</span></strong><span style="font-size: 10pt">:</span><span style="font-size: 10pt"> </span><span style="font-size: 10pt">لیپوکالین وابسته به
ژلاتیناز نوتروفیل </span><span style="font-size: 7pt">(</span><span style="font-size: 7pt">NGAL</span><span style="font-size: 7pt">)</span><span style="font-size: 7pt">N</span><span style="font-size: 8pt">e</span><span style="font-size: 8pt">utrophilic</span><span style="font-size: 7pt"> G</span><span style="font-size: 8pt">elatinase</span><span style="font-size: 7pt"> A</span><span style="font-size: 8pt">ssociated</span><span style="font-size: 7pt"> L</span><span style="font-size: 8pt">ipocaline </span><span style="font-size: 10pt"><span> </span><span lang="AR-SA">به عنوان بیومارکر تشخیص زودرس
آسیبهای حاد کلیه، جایگاه ویژهای پیدا کرده است. ولی اینکه در تمام آسیبها به
علل مختلف ارزش تشخیصی بالایی داشته باشد نیاز به مطالعات بیشتری وجود دارد. کنتراست
نفروپاتی از جمله این موارد است که علیرغم مطالعات موجود، ارزش پیشگویی کننده </span></span><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt"> در تشخیص
زودرس نارسایی کلیه ناشی از مواد حاجب روشن نیست. هدف این مطالعه بررسی نقش این
بیومارکر در تشخیص زود هنگام کنتراست نفروپاتی است. </span><strong><em><span style="font-size: 10pt"><br></span></em></strong></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">روش
بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در این مطالعه، 122 بیمار کاندیدای آنژیوگرافی/ آنژیوپلاستی در بهار و
تابستان سال 88 وارد مطالعه شدند. در نمونههای ادراری ساعات مختلف غلظت </span><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt"> اندازهگیری و
میزان آن در بیماران مبتلا و غیرمبتلا مقایسه شد. <br></span></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span style="font-size: 10pt"></span><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">37 نفر (3/30%) از
بیماران کنتراست نفروپاتی داشتند. افزایش غلظت ادراری </span><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt">، 12 ساعت پس
از پروسیجر به ترتیب در مبتلایان و غیرمبتلایان 63/105</span><span style="font-size: 8pt">±</span><span style="font-size: 10pt">62/90 و 8/45</span><span style="font-size: 8pt">±</span><span style="font-size: 10pt">6/27، (0001/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) و غلظت
ادراری آن 24 ساعت پس از پروسیجر 7/117</span><span style="font-size: 8pt">±</span><span style="font-size: 10pt">78/79 و 84/52</span><span style="font-size: 8pt">±</span><span style="font-size: 10pt">92/30، (002/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) بود. حساسیت و ویژگی </span><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt"> ادرار 12 ساعت پس از پروسیجر با </span><span style="font-size: 7pt">C</span><span style="font-size: 8pt">ut-off</span><span style="font-size: 10pt"> <span lang="AR-SA">هشت نانوگرم
در میلیلیتر و </span></span><span style="font-size: 7pt">AUC</span><span style="font-size: 10pt"> 75/0، به ترتیب 94% و 25% و ارزش اخباری منفی آن 91% بود. همچنین
حساسیت و ویژگی </span><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt"> ادرار 24 ساعت پس از پروسیجر در </span><span style="font-size: 7pt">C</span><span style="font-size: 8pt">ut-off</span><span style="font-size: 10pt"> 5/5 نانوگرم
بر میلیلیتر با </span><span style="font-size: 7pt">AUC</span><span style="font-size: 10pt"> 70/0، به ترتیب 97% و 24% و ارزش اخباری منفی آن 95% بود. <br></span></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span style="font-size: 10pt"></span><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 7pt">NGAL</span><span style="font-size: 10pt"> ادرار
بیومارکری حساس برای تشخیص زودرس نارسایی حاد کلیوی ناشی از ماده حاجب میباشد.<span> </span></span></p>
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<!--stripped--> <strong>Background</strong><strong>:</strong> Neutrophil
Gelatinase Associated Lipocalin (NGAL) is a new biomarker which can predict acute kidney injury (AKI) in critically ill patients.
Usefulness of NGAL in the early diagnosis of all types of AKI is under question. We
hypothesized NGAL is an early predictive biomarker of contrast-induced nephropathy (CIN). <br><strong>Methods</strong><strong>:</strong> In this process evaluation study, we enrolled 122 patients (Mean age 59.7±10.8 years) undergoing elective
angiography/angioplasty with contrast media during April to September 2009. Serial urine samples were
analyzed in a double-blind fashion by NGAL enzyme-linked immunosorbent assay. CIN was defined as a 25% increase in baseline serum creatinine. <br><strong>Results</strong> <strong>:</strong> The prevalence of CIN was 30.3%. Significant elevations in urinary NGAL concentrations were noted within 12-h and 24-h after the procedure in patients with CIN. NGAL concentrations after 12 hours was 90.62±105.63 vs. 27.6±45.8 ng/ml in patients with and without CIN, respectively P=0.0001, and 79.78±117.7 vs. 30.92±52.84 ng/ml, 24 hours afterwards P=0.002. Some patients had AKI after five days of exposure rather than the second day (P=0.0001). We found using a cut-off point
of 8
ng/ml with a sensitivity, specificity, negative predictive value and area under
the ROC curve
94%, 25%, 91% and
0.75 respectively
are good for the prediction of CIN in 12-h urinary NGAL and a cut-off point of 5.5 ng/ml with respective values of 97%,
24%, 95% and 0.70 for 24-h urinary NGAL.<br><strong>Conclusion:</strong> Urine NGAL may represent a sensitive
early biomarker of acute AKI after angiography/angioplasty. We recommend the routine measurement
of NGAL in
high risk patients receiving contrast agents.</p>
لیپوکالین وابسته به ژلاتیناز نوتروفیل،کنتراست نفروپاتی،آنژیوگرافی،آنژیوپلاستی
Angiography,angioplasty,contrast-induced nephropathy,neutrophil gelatinase-associated lipocalin
502
508
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-207&slc_lang=fa&sid=1
Pahlavan-Sabbagh
MR
محمد رضا
پهلوان صباغ