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전신성염증반응증후군 환자에서 급성기반응물질로서 호중구 젤라틴분해효소 연관 리포칼린의 의의

Significance of Neutrophil Gelatinase-Associated Lipocalin Level as an Acute-Phase Reactant in Patients with Systemic Inflammatory Response Syndrome

이지은|최종원|한승백|문연숙|제영수
대한진단검사의학회 (Korean Society For Laboratory Medicine)|2014.10|Laboratory Medicine Online|제4권 제4호|pp. 191-197

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키워드

Neutrophil gelatinase-associated lipocalinSystemic inflammatory response syndromeAcute-phase reactant

초록

배경: 본 연구는 염증성질환 환자에서 급성기반응물질과 혈청크레아티닌(serum creatinine, sCr) 상승에 대한 지표로서 혈장 호중구젤라틴분해효소연관리포칼린(neutrophil gelatinase-associated lipocalin, NGAL) 농도의 의의에 대하여 조사하였다. 방법: 전체 63명의 전신성염증반응증후군(systemic inflammatory response syndrome, SIRS)환자와 149명의 non-SIRS환자를 조사하였다. 혈장 NGAL (plasma NGAL, pNGAL) 농도는 형광면역법으로 분석하였다. sCr은 72시간 동안 매일 측정하였고 sCr농도의 상승 여부를 조사하였다. 고감도 C-반응성단백(high-sensitivity C-reactive protein, hsCRP)은 라텍스비탁법을 이용하여 분석하였다. 결과: SIRS 환자에서 pNGAL의 중앙값은 154 ng/mL였는데, non-SIRS 환자군의 86 ng/mL과 정상대조군의 62 ng/mL보다 각각 유의하게 높았다(P<0.001). SIRS 진단을 위한 pNGAL과 hsCRP의 ROC곡선 아래 면적(area under the ROC curve, AUC)은 각각 0.725 (95% CI, 0.664-0.781)와 0.749 (95% CI, 0.685-0.809)였고, 두 지표 간 AUC에 유의한 차이는 없었다(P=0.375). 다변량 회귀분석에서 pNGAL의 대수값은 hsCRP (β=0.546. P<0.001)와 혈청알부민/sCr 비(serum albumin/sCr ratio, sACR) (β=-0.351, P<0.001)와 유의한 연관성이 있었다. SIRS군에서 48-72시간 동안, 양의 delta sCr에 대한 pNGAL의 AUC는 0.649 (95% CI, 0.542-0.746, P=0.023)였다. 결론: pNGAL은 전신성염증질환 여부를 판단하는 데 hsCRP에 비교될 정도의 민감도를 보이는 염증관련인자로 생각된다. pNGAL을 측정함으로써 전신성염증반응증후군 환자에서 48-72시간 동안 sCr 상승 가능성에 대한 추가적인 정보를 얻을 수 있을 것이다.

Abstract

Background: We investigated the significance of plasma neutrophil gelatinase-associated lipocalin (pNGAL) level as an acute-phase reactant and an index for an increase in serum creatinine (sCr) level in patients with inflammatory diseases. Methods: A total of 63 patients with systemic inflammatory response syndrome (SIRS) and 149 without SIRS were evaluated, and pNGAL level was determined using a fluorescence immunoassay. sCr levels were measured daily during three days, and the difference between the initial and follow-up sCr levels was defined as a delta sCr value. Serum albumin/sCr ratio (sACR) was calculated. High-sensitivity C-reactive protein (hsCRP) level was determined using a latex turbidometric method. Results: The median pNGAL level in the SIRS group (154 ng/mL) was significantly higher than that in the non-SIRS (86 ng/mL) and control (62 ng/mL) groups (P<0.001, respectively). The area under the ROC curve (AUC) of pNGAL for diagnosing SIRS was 0.725 (95% CI, 0.664-0.781), which was not significantly different from that of hsCRP (0.749; 95% CI, 0.685-0.809; P=0.375). Multivariate regression analyses revealed that log-pNGAL was significantly associated with hsCRP (β=0.546, P<0.001) and sACR (β=0.351, P<0.001). The AUC of pNGAL for the positive delta sCr in 48-72 hr was 0.649 (95% CI, 0.542-0.746, P=0.023) in the SIRS group. Conclusions: pNGAL is comparable to hsCRP as an inflammation-related parameter, and its measurement may provide additional information for a potential increase in sCr during 48-72 hr in patients with SIRS.

참고문헌 (27)

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