炎症指标对全身性感染患者AKI的预测价值：7年753例病例报告分析  

Predictive value of inflammatory markers for acute kidney injury in sepsis patients： analysis of 753 cases in 7 years

作　　者：周晓[1] 刘景峰[1] 冀晓俊[1] 杨晓卫[1] 段美丽[1] Zhou Xiao;Liu Jinpfeng;Ji Xiaojun;Yang Xiaowei;Duan Meili(Department of lntensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,100050

出　　处：《中华危重病急救医学》2018年第4期346-350,共5页Chinese Critical Care Medicine

基　　金：北京市科技计划项目（Z141107002514119）

摘　　要：目的探讨炎症指标对全身性感染患者合并急性肾损伤（AKI）的预测价值。方法采用回顾性观察性研究，选择2010年3月1日至2017年11月1日入住首都医科大学附属北京友谊医院重症医学科（ICU）超过24 h的全身性感染成人患者，收集患者入ICU即刻白细胞计数（WBC）、红细胞沉降率（ESR）、中性粒细胞与淋巴细胞比值（NLR）、C-反应蛋白（CRP）、降钙素原（PCT）等炎症指标。根据入ICU 24 h内是否发生AKI将患者分组，并根据改善全球肾脏病预后组织（KDIGO）-AKI分期标准进行亚组分析。以有统计学意义的炎症指标绘制受试者工作特征曲线（ROC），评估其对全身性感染患者发生AKI的预测价值。结果共纳入753例全身性感染患者，24 h内发生AKI 405例，发生率为53.8%。AKI 1期118例（占15.7%），2期48例（占6.4%），3期239例（占31.7%）。AKI组PCT明显高于非AKI组〔μg/L：4.98（1.51，32.75）比3.00（0.37，11.40），P〈0.01〕，且AKI 2期组PCT显著高于AKI 1期和3期组〔μg/L：27.86（4.80，37.26）比3.00（0.98，16.10）、4.98（1.51，42.55），均P〈0.01〕。AKI组ESR虽低于非AKI组（mm/1 h：45.25±37.42比52.28±34.89，P〈0.01），但各AKI分期组间差异无统计学意义。AKI组CRP高于非AKI组〔mg/L：96.00（42.20，160.00）比73.60（21.01，157.50）〕，但差异无统计学意义（P〉0.05）。AKI组与非AKI组比较以及AKI各分期组间比较，WBC、NLR差异均无统计学意义。ROC曲线分析显示，PCT预测全身性感染患者发生AKI的ROC曲线下面积（AUC）为0.619，95%可信区间（95%CI）为0.545~0.689（P〈0.01）；当截断值〉0.4 μg/L时，敏感度为94.2%，特异度为26.5%，准确性为64.2%，阳性预测值为61.6%，阴性预测值为78.6%。结论PCT可能对全身性感染患者出现AKI具有预测价值。ObjectiveTo evaluate different inflammation markers for predicting the risk of acute kidney injury （AKI） in sepsis patients.MethodsA retrospective observational study was conducted. The adult patients with sepsis for more than 24 hours admitted to intensive care unit （ICU） of Beijing Friendship Hospital, Capital Medical University from March 1st, 2010 to November 1st, 2017 were enrolled. Inflammatory markers such as white blood cell count （WBC）, erythrocyte sedimentation rata （ESR）, neutrophil and lymphocyte ratio （NLR）, C-reactive protein （CRP）, procalcitonin （PCT）, etc. were collected at ICU admission. The patients were divided into different groups according to the 24-hour AKI, and subgroup analysis was conducted according to the criteria of the Global Renal Disease Prognostic Organization （KDIGO）-AKI staging. The receiver operating characteristic curve （ROC） was plotted with statistically significant inflammatory markers to assess the predictive value of AKI for patients with systemic infection.ResultsA total of 753 patients with sepsis were enrolled. 405 AKI patients were diagnosed within 24 hours, with a prevalence of 53.8%. There were 118 cases （15.7%） in AKI stage 1, 48 cases （6.4%） in stage 2 and 239 cases （31.7%） in stage 3. PCT in AKI group was significantly higher than that in non-AKI group [μg/L： 4.98 （1.51, 32.75） vs. 3.00 （0.37, 11.40）, P 〈 0.01]. PCT of AKI stage 2 group was significantly higher than that of AKI stage 1 and 3 groups [μg/L： 27.86 （4.80, 37.26） vs. 3.00 （0.98, 16.10）, 4.98 （1.51, 42.55）, both P 〈 0.01]. Although ESR in AKI group was lower than that of non-AKI group （mm/1 h： 45.25±37.42 vs. 52.28±34.89, P 〈 0.01）, there was no significant difference among the subgroups. CRP in AKI group was slightly higher than the non-AKI group [mg/L： 96.00 （42.20, 160.00） vs. 73.60 （21.01, 157.50）], but the difference was not statistically significant （P 〉 0.05）. There was no significant differen

关 键 词：急性肾损伤 全身性感染 炎症指标 降钙素原 

分 类 号：R459.7[医药卫生—急诊医学]