The Diagnosis Value Of SNGAL And UNGAL In Paraquat Poisoning With Acute Kidney Injury

Background and objective:Paraquat(PQ)is an efficient herbicide,is the most common type of pesticide poisoning in our country,however there is no specific antidote for paraquat poisoning.Acute kidney injury(AKI)is one of the common complications of paraquat poisoning,the AKI was found to be one of the independent risk factors of death in patients with paraquat poisoning,the mortality rate of patients with acute kidney injury of paraquat poisoning as high as 66%.The high mortality rate is mainly due to the lack of early and sensitive diagnostic methods,the patients can not be treated in time.Therefore,early and timely detection of paraquat poisoning patients with AKI,and timely intervention treatment has become a key factor to improve the survival rate.The serum creatinine and urea as the traditional diagnostic marker in acute kidney injury,they can not accurately reflect the early renal damage.The study found that neutrophil gelatinase associated lipocalin(NGAL)has a high correlation with acute kidney injury,which may be useful for early diagnosis of acute kidney injury,prevention,treatment and improve the prognosis,NGAL becomes a new biomarker for clinical diagnosis of acute kidney injury.However,the application of paraquat poisoning with acute kidney injury is not very clear.The purpose of this study was to investigate the application value of serum and urine NGAL in paraquat poisoning with acute kidney injury.Research methods:100 cases of patients with acute paraquat poisoning were admitted from the Department of emergency medicine of the First Affiliated Hospital of Zhengzhou University from December 2014 to December 2015.The patients were divided into two group: acute kidney injury group and non acute kidney injury group,all patients were detected the serum and urine NGAL value for first day,third day and fifth day,at the same time to record the changes of serum creatinine and urea level.The differences of serum creatinine,urea,serum NGAL and urine NGAL were analyzed by independent sample t test.The receiver operating characteristic curve(ROC)detection and analysis of prediction indexes of acute paraquat poisoning with AKI sensitivity and specificity,and determine the best diagnostic critical value of serum NGAL and urine NGAL.Spearman correlation analysis was to determine the correlation among the serum NGAL,urine NGAL and paraquat poisoning with acute kidney injury.Results:The results showed that there were significant differences of serum NGAL and urine NGAL value between AKI group and the non AKI group in the first day(p<0.05),but there was no significant difference of serum creatinine and urea level between the two groups in the first day(p>0.05).In acute kidney injury group,the serum NGAL and urine NGAL were still at a high level at third day,while the serum creatinine gradually increased of the third day.In the third and fifth days,there were significance statistical differences in serum NGAL,urine NGAL,serum creatinine and urea between the two groups.ROC curve analysis showed that on the first day the AUC of serum NGAL,urine NGAL,serum creatinine and urea were 0.85,0.89,0.73,0.64,early urine NGAL and serum NGAL AUC was significantly higher than serum creatinine and urea AUC,on the third day the AUC of serum NGAL,urine NGAL,serum creatinine and urea were 0.89,0.88,0.88,0.86,there were no significant differences among them.on the fifth day the AUC of serum NGAL,urine NGAL,serum creatinine and urea were 0.85、0.87、0.89、0.86,there were also no significant differences among them.The results of Spearman correlation analysis showed that there was significant positive correlation between the serum NGAL,urine NGAL and paraquat poisoning with acute kidney injury(p<0.05).Conclusions:Serum NGAL and urine NGAL are closely associated with acute kidney injury of paraquat poisoning patients,sNGAL and uNGAL can be used as a sensitive and reliable new biomarker for acute kidney injury in patients with paraquat poisoning.