본 연구는 급성 신손상으로 입원한 환자를 대상으로 NGAL과 신손상의 지표 및 중 증도와의 관련성을 평가하고자 하였다.
상관분석으로 BUN,Creatinine과 NGAL 각각의 두 변수와의 관련성으로 확인해보 고,NGAL을 독립변수로 하여 Creatinine에 대한 다중 회귀분석을 하였다.급성 신손 상을 3단계로 나누는 기준을 사용하여 Creatinine4이상 이거나 투석을 한 경우를 카 이제곱 검정과 t-test를 하였다.
대상자는 총 40명,평균연령 64.2±14.8세로 남자가 25명(62.5%)이었고,여자가 15명 (37.5%)이었다.NGAL의 평균은 895.2±419.4이고,Creatinine6.0±3.9로 높았다. NGAL 이 증가할수록 Creatinine이 유의하게 증가하였다(r=0.351;p=0.027).연령과 성별을 보 정한 상태에서 다중 회귀분석을 통해 NGAL과 Creatinine과의 관련성을 살펴본 결과, NGAL이 증가할 때 Creatinine이 유의하게 증가하였다(B=0.003,SE=0.001,p=0.022). Creatinine이 4이상이거나 투석을 한 경우를 3기로 정했을 때,3기 여부에 따른 NGAL 은 차이가 없었다.
결론적으로 일부 급성 신손상 환자를 대상으로 NGAL과 다른 기타변수들과의 관련 성을 보니 Creatinine과는 상관성을 보였으나, NGAL과 중증도(투석여부,Creatinine4 이상일 때)와는 관련성이 없었다.향후 대규모의 연구를 통해 결과를 확인할 필요가 있다.
23
-VI .참고문헌
AnjaHF,RinaldoB,PrasadD,MichaelB,DavidS,GeorgeM,UlrichF,DuskaD, MichaelH.,Thepredictiveperformanceofplasmaneutrophilgelatinase-associated lipocalin (NGAL) increases with grade of acute kidney injury. Nephrology DialysisTransplant5:3349-3351,2009.
Ahn HJ., Evaluation of serum neutrophil gelatinaseassociated lipocalin(NGAL) activity :Ofchronic renalfailure serum neutrophilgelatinase-associated lipocalin (NGAL)rating.KangwonNationalUniversity173(18):452,2013.
Bachorzewska-GajewskaH,MalyszkoJ,SitniewskaE,MalyszkoJS,DobrzyckiS., Neutrophilgelatinase-associated lipocalin (NGAL) correlations with cystatin C, serum creatinineandeGFR inpatientswithnormalserum creatinineundergoing coronaryangiography.NephrolDialTransplant22(1):295-6,2006.
Bagshaw SM,Bennett M,Haase M,Haase-Fielitz A,Egi M,Morimatsu H, D'amico G,Goldsmith D,Devarajan P,Bellomo R.,Plasmaand urineneutrophil gelatinase-associated lipocalin in septicversusnon-septicacutekidney injury in criticalillness.IntensiveCareMed36(3):452-61,2010.
Brenner.,Thekidney5thPhiladelphia.W B Saunderscompany1200-1252,1996.
Di Grande A, Giuffrida C., Neutrophil gelatinase-associated lipocalin: a novel biomarker for the early diagnosis of acute kidney injury in the emergency departmentetc.EurRevMedPharmacoSci13(3):197-200,2009.
Finco DR,Duncan JR.,Evaluation ofblood urea nitrogen and serum creatinine concentrations as indicators ofrenaldysfunction:a study of111 cases and a review ofrelatedliterature.JAm VetMedAssoc168(7):593-601,1976.
GernotS,WernerR,RonaldO,RupertHP,FranzQ,MartiniTW,RobertZ,Philipp S,Marianne B,Klemens W and Joerg HH.,Early detection and intervention using neutrophil gelatinase-associated lipocalin (NGAL) may improve renal outcome ofacute contrastmedia induced nephropathy:A randomized controlled trialin patients undergoing intra-arterialangiography (ANTI-CIN Study).BMC Nephrology1471-2369,2011.
24
-Han WK,WaikarSS,Johnson A.,Urinary biomarkers in the early diagnosis of acutekidneyinjury.KidneyInt6:501-509,2008.
Hilde RH,Bakker J,Lesaffre EM, Noble JL.,Neutrophil gelatinase-associated lipocalin atICU admission predicts fora acute kidney injury in adultpatients. Am JRespirCritCareMed183(7):907-14,2011.
Hilde RH, Michiel G. H. Betjes, Jan Bakker., Neutrophil gelatinase-associated lipocalin clearance during veno-venous continuous renal replacementtherapy in critically illpatients Intensive Care Medicine 2156-2157, 2010.
Jack,Ph.D.,TheLevelandInfluencingFactorsofBloodSerumvegf.NGAL inType 2DiabetesandPatientswithRenalDamage.Medicalresearch2013.
JoSK,JoWY.,AcuteKidneyInjury:DifferentialDiagnosisand New Biomarker. TheKoreanJournalorMedicine.2012;6:5-10.
Kim BS.Acute Kidney Injury : Definition,Incidence,Etiology,Outcome.The Korean JournalorMedicine4:1-4,2012.
Kümpers P,HaferC,Lukasz A,Lichtinghagen R,Brand K,FliserD,Faulhaber Walter R, Kielstein JT., Serum neutrophil gelatinase-associated lipocalin at inception ofrenalreplacementtherapy predicts survivalin critically illpatients withacutekidneyinjury.CritCare14(1):R9,2010.
LeeEY.,Serum NeutrophilGelatinase-Associated Lipocalin and Interleukin-18as PredictiveBiomarkers forDelayed GraftFunction AfterKidney Transplantation.
Master'sThesis,YonseiUniversity2011.
Lyman JL., Blood urea nitrogen and creatinine. Emerg Med Clin North Am 4(2):223-33,1986.
Mark M. Mitsnefes, Thelma S. Kathman, Mishra J, Kartal J, Philip R.
Khoury, Thomas L, Nickolas, Barasch J, Devarajan P., Serum neutrophil gelatinase-associated lipocalin as a marker ofrenalfunction in children with chronickidneydisease.PediatricNephrology101-108,2007.
McGraw-Hill., Harrison's Principles of internal medicine 14th New york.
1504-1512,1998.
McWilliam SJ,AntoineDJ,SabbisettiV,TurnerMA,FarragherT,BonventreJV,
25
-Park BK,Smyth RL,Pirmohamed M.,Mechanism-based urinary biomarkers to identify the potential for aminoglycoside-induced nephrotoxicity in premature neonates:aproof-of-conceptstudy.PLoS One7(8):e43809,2012.
MishraJ,MaQ,PradaA.,Identificationofneutrophilgelatinase-associatedlipocalin asanovelearly urinary biomarkerforischemicrenalinjury.JAm SocNephrol 14:2534-2543,2003.
Namgoong MK.,Definition and Diagbostic Criteria of Acute Kidney Injury.J KoreanSocPediatrNephrol15:101-106,2011.
Nickolas TL,O'Rourke MJ,Yang J,Sise ME,Canetta PA,Barasch N,Buchen C,Khan F,MoriK,Giglio J,Devarajan P,Barasch.,Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury.Ann Intern Med148(11):810-9,2008.
NM El Raggal, SM Khafagy, *NH Mahmoud and SA El Beltagy,. Serum Neutrophil Gelatinase-AssociatedLipocalin asaMarkerofAcuteKidney Injury in AsphyxiatedNeonates.Pediatrics,and*ClinicalPathology50(5):459-62,2013.
NickolasTL,O'RourkeMJ,Yang J,SiseME,CanettaPA,Barasch N,Buchen C, KhanF,MoriK,GiglioJ,DevarajanP,Barasch.,Sensitivityandspecificityof a single emergency department measurement of urinary neutrophil gelatinase-associatelipocalin fordiagnosing acutekidney injury.Ann InternalMed 148(11):810-9,2008.
Moon SJ,Park HB,Yoon SY,LeeSC..,Urinary biomarkersforearly detection of recovery in patients with acute kidney injury.J Korean Med Sci28(8):1181-6, 2013.
PhilippK,Carsten H,AlexanderL,RalfL,KorbinianB,DaniloF,RobertFW and Jan T K.,Serum neutrophilgelatinase-associated lipocalin atinception ofrenal replacementtherapy predicts survivalin critically illpatients with acute kidney injury.CriticalCare14-19,2010.
PiccinniP,Dan M,BarbaciniS,Carraro R,LietaE,Marafon S.,Earlyisovolaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med 32:802,2006.80-86,2005.
26
-Prasad Devarajan.,Neutrophilgelatinase-associated lipocalin—an emerging troponin forkidneyinjury.NephrologyDialysisTransplantation3737-3743,2008.
Prasad Devarajan,Ronco C,Bellomo R,Kellum JA.,Emerging biomarkers for AcuteKidneyInjury.InCLI203-212,2007.
Prabhu A, Sujatha DI, Ninan B, Vijayalakshmi MA., Neutrophil gelatinase associatedlipocalinasabiomarkerforacutekidneyinjuryinpatientsundergoing coronary artery bypass grafting with cardiopulmonary bypass.Ann Vasc Surg 24(4):525-31,2010.
HirschR,DentC,Pfriem H,AllenJ,BeekmanRH 3rd,MaQ,DastralaS,Bennett M,Mitsnefes M,Devarajan P.,NGAL is an early predictive biomarker of contrast-induced nephropathy in children. International Paediatric Nephrology Association22(12):2089-95,2007.
Schrier RW,Anderson RJ.,Acute tubular necrosis.Disease of the kidney,4th edition Boston:Little.Brownco1379-1388,1988.
Seo YG., S-388: non-cardiac surgery, renal damage indicators associated lipocalin as a second neutrophil gelatinase (NGAL) the availability of. The KoreanJournalorMedicine,2013.
TuladharSM,Püntmann VO,SoniM,PunjabiPP,Bogle RG.,Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalinaftercardiopulmonarybypass.JCardiovascPharmacol53(3):261-6,2009.
ValeriaBarresi,EnricaVitarelli,LucaReggianiBonetti,GiovanniTuccari,Gaetano Barresi., Diagnostic value of neutrophil gelatinase-associated lipocalin(NGAL) immunoexpression in follicular-patterned lesions ofthe thyroid gland.European SocietyofPathology3:319-325,2012.
Vanmassenhove,RaymondV,EviN andWim V B.,Urinaryandserum biomarkers forthe diagnosis ofacute kidney injury:an in-depth review ofthe literature. NephrolDialTransplant28:254-273,2013.
XueJL,Daniels F,StarRA.,Incidence and mortality ofacute renalfailure.Jam Soc Nephrol17:1135-1142,2006.
Yang HN,Boo CS,Kim MG,Jo SK,Cho WY,Kim HK.,Urine neutrophil gelatinase-associated lipocalin:an independentpredictorofadverse outcomes in