何军,张丽,田洪伦,尹科,祝静,周曹
HE Jun,ZHANG Li,TIAN Honglun,YIN Ke,ZHU Jing,ZHOU Cao

• 1:贵州省第二人民医院检验科
• 2:贵州省第二人民医院精神科

摘要(Abstract)：

目的:通过检测伴慢性丙型肝炎(HCV)感染海洛因依赖者血清胱氨酸蛋白酶抑制剂C(Cys-C)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平,评价海洛因依赖伴慢性HCV感染者早期肾损伤。方法:120例海洛因依赖者,分为伴HCV感染组(n=60)和不伴HCV感染(n=60),再按吸食海洛因时间分为<5年组和6~10年组,30例正常人作为对照组;免疫比浊法检测血清Cys-C水平,ELISA法检测血清NGAL水平;采用ROC曲线面积(AUC)评价Cys-C、NGAL水平对海洛因依赖伴慢性HCV感染者早期肾损伤的诊断价值。结果:伴HCV感染<5年组和6~10年组血清Cys-C水平(0.87±0.15、0.94±0.15)mg/L均高于不伴HCV感染组(0.62±0.22、0.74±0.11)mg/L和对照组(0.65±0.09)mg/L,差异有统计学意义(P<0.05);不伴HCV感染6~10年组高于对照组,差异有统计学意义(P<0.05);伴HCV感染6~10年组血清NGAL水平(82.26±25.84)ng/L高于不伴HCV感染<5年组(66.29±22.02)ng/L和对照组(64.98±17.26)ng/L,差异有统计学意义(P<0.05),不伴HCV感染6~10组高于对照组,差异有统计学意义(P<0.05);伴HCV感染<5年组、6~10年组及不伴HCV感染6~10年组Cys-C的AUC分别为0.942、0.977和0.772,P<0.01;伴HCV感染和不伴HCV感染6~10年组NGAL的AUC分别为0.707、0.696,P<0.01。结论:血清Cys-C水平对海洛因依赖伴慢性HCV感染者早期肾损伤有很好诊断价值,而血清NGAL水平仅对在吸食海洛因6年以上者早期肾损伤有一定诊断价值。
Objective: To investigate early renal injury by testing levels of serum cystatin C( CysC),neutrophil gelatinase-associated lipocalin( NGAL) in heroin addicts with chronic HCV infection.Methods: A total of 120 cases of heroin addicts were divided into HCV infection group( n = 60) and non HCV infection group( n = 60),further grouping by standard of using heroin within 5 years( n =30) and 6 ~ 10years( n = 30) group; Meanwhile,30 cases of normal people as control group( n =30); the serum level of NGAL was measured by ELISA assay,while serum Cys-C by immune turbidimetric method. Moreover,ROC curve area under the curve( AUC) was employed in diagnostic value comparison of early renal injury of levels of Cys-C and NGAL in heroin addicts with chronic HCV infection. Results: The level of serum Cys-C with HCV infection within 5 years group and 6 ~ 10 years group( 0. 87 ± 0. 15、0. 94 ± 0. 15) mg /L were higher than that of non HCV infection group( 0. 62 ±0. 22、0. 74 ± 0. 11) mg /L and control group( 0. 65 ± 0. 09) mg /L,differences were statistically significant( P < 0. 05); 6 ~ 10 years group was higher than control group,differences were statistically significant( P < 0. 05); the level of serum NGAL: HCV infection 6 ~ 10 years group( 82. 26 ± 25. 84)ng / L was higher than that non-HCV infection within 5 years group( 66. 29 ± 22. 02) ng /L and control group( 64. 98 ± 17. 26) ng /L,differences were statistically significant( P < 0. 05); 6- 10 years group are higher than control group,differences were statistically significant( P < 0. 05); Cys-C curve( AUC) of HCV infection within 5 years group,6 ~10 years group and 6 ~10 years non HCV infection group were 0. 942,0. 977 and 0. 772 respectively,P < 0. 05; the NGAL AUC in 6 ~ 10 years group with HCV infection and non-HCV infection were 0. 707,0. 696 respectively,P < 0. 05. Conclusions:The serum level of Cys-C has fine diagnostic value to evaluate the early renal injury of heroin addicts with chronic HCV infection,while the levels of serum NGAL level( heroin addition over 6 years) has certain diagnostic value.

关键词(KeyWords)： 胱氨酸蛋白酶抑制剂-C;中性粒细胞明胶酶相关脂质运载蛋白;海洛因依赖;肝炎,丙型,慢性;肾功能衰竭,早期
cystatin C;gelatinase-associated lipocalin;heroin addiction;hepatitis C,chronic;renal failure,early stage

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生厅科学技术基金项目(Gzwkj22011-1-8)

作者(Author): 何军,张丽,田洪伦,尹科,祝静,周曹
HE Jun,ZHANG Li,TIAN Honglun,YIN Ke,ZHU Jing,ZHOU Cao

DOI: 10.19367/j.cnki.1000-2707.2014.05.020

参考文献(References)：

• [1]颜兴伟,杨玉金,龚俊平,等.海洛因依赖者美沙酮维持治疗肝肾功能生化指标的变化[J].现代预防医学,2012(8):2035-2037.
• [2]Bao YP,Liu ZM.Systematic review of HIV and HCV infection among drug users in China[J].International Journal of STD&AIDS,2009(20):399-405.
• [3]Chen X,Xiao YL,Chen Y,et al.Urine neutrophil gelatinase-associated lipocalin and interleukin-18 predict acute kidney injury after cardiac surgery[J].renal failure,2008(30):904-913.
• [4]Sabah MA,Norella K,Rashidi S,et al.Serum neutrophil gelatinase-associated lipocalin and cystatin C are early biomarkers of contrast-induced nephropathy after coronary angiography in patients with chronic kidney disease[J].Angiology,2014(5):436-442.
• [5]急性肾损伤专家共识小组.急性肾损伤诊断与分类专家共识[J].中华肾脏病杂志,2006(22):661.
• [6]rvela K,Maaranen P,Harmoinen A,et al.Cystatin C in diabetics as a marker of mild renal insufficiency after CABG[J].Ann Thorac Cardiovasc Surg,2011(17):77-282.
• [7]Chou KM,Lee CC,Chen CH,et al.Clinical value of NGAL,L-FABP and albuminuria in predicting GFR decline in type 2 diabetes mellitus patients[J].PLoS ONE,2013(1):1-2.
• [8]Antonio L,Valeria C,Valentina D,etal.NGAL as an Early biomarker of kidney disease in joubert syndrome:three brothers compared[J].Renal Failure,2012(34):495!498.
• [9]Han M,Li Y,Liu M,el al.Renal neutrophil gelatinase associated lipocalin expression in lipopolysaccharide-induced acute kidney injury in the rat[J].BMC Nephrol,2012(13):25.
• [10]Manner I,Sagedal S,Roger M.Renal amyloidosis in intravenous heroin addicts with nephrotic syndrome and renal failure[J].Clinical Nephrology,2009(3):224-228.
• [11]曹娅丽,章友康.丙型肝炎病毒感染相关性肾小球肾炎的研究进展[J].中华肾脏病杂志,2009(25):156-159.
• [12]Rashad SB.Hepatitis C virus:from entry to renal injuryfacts and potentials[J].Nephrol Dial Transplant,2007(7):1840-1848.
• [13]Justyna T,Anna W,Robert M.Urine NGAL and KIM-1in children and adolescents with hyperuricemia[J].Pediatr Nephrol,2013(28):1863-1869.

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