血清TRAF-6、MCP-1、sTREM-1、IL-33水平与脓毒症严重程度及与合并急性肾损伤关系的临床分析  

Clinical Analysis of the Relationship between Serum TRAF-6, MCP-1,sTREM-1, IL-33 and Severity of Sepsis and Acute Kidney Injury

作　　者：张琪[1] 姜利[1] 席修明 费雅楠 王鹏[1] 姜琦[1] ZHANG Qi;JIANG Li;XI Xiu-ming;FEI Ya-nan;WANG Peng;JIANG Qi(Intensive Care Unit,Fuxing Hospital,Capital Medical University,Beijing,100038,China;Department of rheumatis,Beijing Haidian Hospital,Beijing,100080,China)

机构地区：[1]首都医科大学复兴医院重症监护室,北京100038 [2]北京海淀医院风湿科,北京100080

出　　处：《现代生物医学进展》2019年第23期4440-4444,共5页Progress in Modern Biomedicine

基　　金：国家科技支撑计划项目(2012BAI11B05).

摘　　要：目的:探讨脓毒症患者血清肿瘤坏死因子受体相关因子(Tumor necrosis factor receptor-related factor,TRAF)-6、单核细胞趋化蛋白(Monocyte chemotactic protein,MCP)-1、可溶性髓样细胞触发受体(Soluble myeloid cell trigger receptor,s TREM)-1、白介素(Interleukin,IL)-33水平的变化及与病情严重程度及合并急性肾损伤(acute kidney injury,AKI)的相关性。方法:选择2014年2月到2018年7月在我医院ICU病房进行诊治的脓毒症患者145例,分析脓毒症相关性急性肾损伤(sepsis-associated AKI,SAKI)的发生情况,比较SAKI和非SAKI患者血清TRAF-6、MCP-1、s TREM-1、IL-33水平,采用Pearson相关分析血清TRAF-6、MCP-1、s TREM-1、IL-33含量与APACHEⅡ评分、SOFA评分的相关性,多因素logistic回归分析脓毒症患者发生SAKI的影响因素。结果:在145例患者中,发生SAKI者69例,发生率为47.6%。SAKI组患者的年龄、性别、原发病、白细胞(white blood cell,WBC)计数、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、体重指数、BUN、Scr与eGFR值与非SAKI组患者对比差异均无统计学意义(P<0.05)。SAKI组患者APACHEⅡ评分、SOFA评分血清TRAF-6、MCP-1、s TREM-1、IL-33含水平含量均显著高于非SAKI组患者(P<0.05)。Pearson相关性分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平与SAKI患者的急性生理和慢性健康Ⅱ(acute physiology and chronic health evaluation II,APACHEⅡ)评分、序贯多器官功能障碍(sequential organ failure assessment,SOFA)评分均呈显著正相关性(P<0.05)。logistic回归分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平升高均为影响SAKI发生的独立危险因素(P<0.05)。结论:血清TRAF-6、MCP-1、s TREM-1、IL-33水平与脓毒症严重程度显著相关,可能作为诊断和治疗SAKI的参考指标及干预靶点。Objective:To investigate the changes of tumor necrosis factor receptor-related factor(TRAF)-6,monocyte chemotactic protein(MCP)-1,soluble myeloid cell triggering receptor(s TREM)-1,interleukin(IL)-33 levels in patients with sepsis and their correlation with the severity of disease and acute kidney injury(AKI).Methods:A total of 145 patients with sepsis who were treated in the ICU ward of our hospital from February 2014 to July 2018 were enrolled.The incidence of sepsis-associated acute kidney injury(SAKI)were analyzed.SAKI were compared.Serum levels of TRAF-6,MCP-1,s TREM-1,and IL-33 in patients with non-SAKI,and Pearson correlation analysis of serum TRAF-6,MCP-1,s TREM-1,IL-33 and APACHE II scores,SOFA scores Correlation,multivariate logistic regression analysis of the influencing factors of SAKI in patients with sepsis.Results:Of the 145 patients,69 had SAKI,an incidence of47.6%.Age,gender,primary disease,white blood cell(WBC)count,C reactive protein(CRP),procalcitonin(PCT),body mass index,BUN,Scr and There were no significant difference between the eGFR value and the non-SAKI group(P<0.05).The APACHE II score,SOFA score,serum TRAF-6,MCP-1,s TREM-1,and IL-33 levels in the SAKI group were significantly higher than those in the non-SAKI group(P<0.05).Pearson correlation analysis showed serum TRAF-6,MCP-1,s TREM-1,IL-33 levels and acute physiology and chronic health evaluation II(APACHE II)scores in SKI patients,sequential multiple organs Sequential organ failure assessment(SOFA)scores were significantly positively correlated(P<0.05).Logistic regression analysis showed that elevated levels of serum TRAF-6,MCP-1,s TREM-1,and IL-33 were independent risk factors for SAKI(P<0.05).Conclusion:The serum TRAF-6,MCP-1,s TREM-1,and IL-33 levels were significantly associated with the severity of sepsis and may serve as references for the diagnosis and treatment of SAKI.

关 键 词：脓毒症 急性肾损伤 TRAF-6 MCP-1 STREM-1 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]