ABSTRACT
Objective To investigate the value of serum neutrophil gelatinase-associated lipocalin (sNGAL),urinary neutrophil gelatinase -associated lipocalin (uNGAL),and serun cystatin C (CysC) in the early diagnosis of acute kidney injury (AKI) in patients with liver cirrhosis.Methods A total of 236 patients with liver cirrhosis and normal renal function who visited The Red Cross hospital of Hannan District from January 2015 to March 2017 were enrolled,and according to the presence or absence of AKI within 48 hours after admission,these patients were divided into AKI group with 78 patients and non-AKI group with 158 patients.Another 100 healthy subjects who underwent physical examination were enrolled as control group.ELISA was used to measure sNGAL,uNGAL,and serum CysC,and serum creatinine (SCr) and glomerular filtration rate (GFR) were compared between groups.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the SNK-q test was used tor further comparison between two groups.A Pearson correlation analysis was also performed,and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these indices.Results At 48 hours after admission,there were significant differences in sNGAL,uNGAL,and CysC between the AKI group and the non -AKI group/control group (all P ＜ 0.05).The patients in the AKI group were stratified by AKI stage based on the criteria for kidney injury,and the patients with a higher stage had significantly higher levels of sNGAL and uNGAL than those with a lower stage (both P ＜ 0.05).The levels of sNGAL,uNGAL,and CysC started to increase at 6 hours after admission,while Scr and GFR started to change at 48 hours after admission,i.e.,sNGAL and uNGAL increased significantly earlier than Scr and GFR (P ＜ 0.05).In the AKI group,sNGAL,uNGAL,and CysC were positively correlated with SCr (r =0.650,0.681,and 0.581,all P ＜ 0.05).According to the ROC curve analysis,sNGAL had an area under the ROC curve (AUC) of 0.845 ± 0.435,an optimal cut-off value of 542.68 μg/L,a sensitivity of 0.824,and a specificity of 0.794,uNGAL had an AUC of 0.836-±0.326,an optimal cut-off value of 75.12 μg/L,a sensitivity of 0.816,and a specificity of 0.766,and CysC had an AUC of 0.818 ±0.267,an optimal cut-off value of 1.48 mg/L,a sensitivity of 0.808,and a specificity of 0.732.Conclusion NGAL and CysC can be used as indices for the early diagnosis of AKI and have great significance in evaluating renal injury and developing treatment measures for patients with liver cirrhosis.
ABSTRACT
BACKGROUND: Conservative treatment of osseous gonarthritis (OG) is mainly to reduce the loading of knee joint and maintain muscle exercise,and non-steroidal anti-inflammatory drugs serve as supplements in case of acute occurrence.OBJECTIVE: To investigate the effect of combination of intraarticular in jection of hyaluronate and pain-point injection of betamethasone in improving the pain symptom in patients with OG.DESIGN: Open experiment.SETTING: Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences.PARTICIPANTS: We selected 45 OG patients, who were aged 40 to 85years and received treatment in the clinic of Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences between January 2004 and October 2004.METHODS: OG parenteral solution was intraarticularly injected into the knee joint, 2.5 mL once a week, 5 weeks set as a disease course. Pain points around knee joint were searched for following thorough physical examination. Anti-inflammatory analgesic solution of 2.0-3.0 mL was injected at each pain point. Physical examination was repeated before treatment in each week. Injection at pain points was maintained if they were still present. Intraarticular injection of hyaluronate was performed only when the pain points disappeared after treatment.MAIN OUTCOME MEASURES: ① Pain score at rest and at exercise.② Time when pain disappeared and times of betamethasone administration.RESULTS: Totally 45 patients entered the result analysis. ① Pain at rest and at exercise 1 week after combination treatment of intraarticular injection of hyaluronate and pain-point injection of betamethasone was ignificantly lessened compared to that before treatment (P ＜ 0.01). Pain relief was more significant at rest than at exercise (P ＜ 0.01). ② Pain disappeared at (17.07±6.00)days after treatment on average. The average times of betamethasone administration was (2.42±0.78) times. ③ No local joint pain and other adverse reactions occurred after administration in any case.CONCLUSION: Combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone can effectively relieve the pain symptom of osseous gonarthritis, with no obvious adverse reactions.