Objective To determine the role of serum and urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in the diagnosis of urinary system disease induced acute kidncy injury (AKI)in children.Methods A prospective clinical study was performed which involved 102 children admitted to Department of Pediatic Nephrology,Shengjing Hospital.Patients were classified by the pediatric modified RIFLE (pRIFLE) criteria for AKI.Serum and urinary NGAL and KIM-1 were detected by ELISA method.The sensitivity and specificity of NGAL and KIM-1 in children with AKI in early stage was evaluated using ROC curve analysis.For these patients who had already been diagnosed AKI,NGAL and KIM-1 were also detected on day 1,4,7,and the correlation analysis was performed with corresponding serum creatinine.Results A total of 102 patients were enrolled in the study,43 patients were diagnosed AKI including 18 AKI-R,10 AKI-I,and 15 AKI-F.Serum and urinary NGAL,KIM-1 was elevated before serum creatinine in the patients with AKI and there was statistically significant difference compared with non AKI group and normal group.ROC curve analysis showed the area under the curve of serum NGAL was 0.89 (95％ CI 0.65-0.91) and urinary NGAL was 0.84 (95％ CI 0.62-0.90)which were better than KIM-1.Correlations between serum,urinary NGAL and serum creatinine were observed with coefficients at r =0.79(P ＜ 0.01)and r =0.62(P＜0.01),respectively.Correlation coefficients between serum,urinary KIM-1 and serum creatinine were r =0.52 (P ＜ 0.05),r =0.55 (P ＜0.05),respectively.Conclusion Serum and urinary NGAL and KIM-1 were elevated in the children with AKI before serum creatinine,which could be the early biomarker for AKI diagnosis,In addition,these two indicators are correlated with serum creatine in the event of AKI.%目的 评价血清和尿中中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM-1)在儿童泌尿系统疾病致急性肾损伤(AKI)诊断中的作用.方法 收集我院小儿肾内科收入院的泌尿系统疾病患儿共102例,均检测血清和尿中的NGAL、KIM-1水平,以AKI pRIFLE为分组标准,评价血清和尿中NGAL、KIM-1在儿童急性肾损伤早期诊断中的敏感性和特异性,并进行ROC曲线分析.对符合AKI诊断的患儿,分别检测诊断AKI后第1天、第4天、第7天的血清和尿中的NGAL、KIM-1水平,并与当天相应的血肌酐(Scr)进行相关分析.结果 入选102例患儿中,43例符合AKI pRIFLE诊断标准,18例患儿为AKI-R期,10例患儿为AKI-I期,15例患儿为AKI-F期.AKI组患儿的血清和尿中NGAL、KIM-1水平在Scr没有升高之前已经升高,与非AKI组及正常对照组比较,这2个指标的组间差异有统计学意义(P＜0.05).血清NGAL的ROC曲线下面积(AUC)为0.89(95％ CI 0.65～0.91),尿中NGAL的AUC为0.84(95％ CI 0.62～0.90),均好于血清和尿中的KIM-1水平.血清和尿中的NGAL水平与Scr相关(r分别为0.79、0.62,P＜0.01)；血清和尿中KIM-1水平与Scr相关(r分别为0.52、0.55,P＜0.05).结论在儿童泌尿系统疾病致AKI时,血清和尿中的NGAL、KIM-1在Scr没有升高之前已经升高,是诊断儿童AKI的早期生物标志物.在发生AKI后,这两个指标与Scr有相关性.
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