感染性休克患者急性肾损伤发生的影响因素及预测其发生的相关指标研究  

Analysis of influencing factors and predictive parameter of acute kidney injury in sepsis shock patients

作　　者：曾帆[1] 兰蕴平[1] 吴娅秋[1] 雷雨[1] 刘荣安 黄晓波[1] ZENG Fan;LAN Yun-ping;WU Ya-qiu;LEI Yu;LIU Rong-an;HUANG Xiao-bo(Department of Intensive Care Unit,Sichuan Provincial People's Hospital,Chendu 610000,China)

机构地区：[1]四川省人民医院重症医学中心

出　　处：《中国实用内科杂志》2019年第12期1060-1063,共4页Chinese Journal of Practical Internal Medicine

基　　金：四川省科技厅重点研发项目，编号：2017SZ0138;四川省干保部保健科研课题，编号：川干研2015-204

摘　　要：目的探讨影响感染性休克患者急性肾损伤(acute kidney injury,AKI)发生的因素及相关指标对AKI发生的预测价值。方法收集四川省人民医院2015年1月至2018年12月收治感染性休克患者256例,分为AKI组与非AKI组,比较两组微小核糖核酸125(miRNA-125)、白介素6(IL-6)、血清中性粒细胞明胶酶相关载脂蛋白(NGAL)、肿瘤坏死因子a(TNF-a)等水平,采用多因素Logistic回归分析与AKI发生的相关指标及预测价值。将AKI患者分为轻中度AKI组(AKI 1-2期)和重度AKI组(AKI 3期),比较两组间指标的差异。结果AKI患者组miRNA-125、NGAL水平高于非AKI组(P<0.05)。肌酐(OR 1.03,95%CI 0.88~1.36),肾小球滤过率(OR 1.23,95%CI 0.75~2.01),miRNA-125(OR 1.56,95%1.02~2.10),NGAL(OR 1.32,95%0.83~1.67)是影响AKI发生的因素(均P<0.05)。重度AKI患者组miRNA-125、TNF-a、NGAL水平高于轻中度AKI患者组(均P<0.05)。miRNA-125预测AKI的发生曲线下面积为0.80(95%CI 0.75~0.83),最佳阈值32.1,敏感度81.5%,特异度76.2%。结论肌酐、肾小球滤过率、miRNA-125、NGAL水平是影响AKI发生的因素,miRNA-125水平可以较好地预测AKI的发生。Objective To investigate the influencing factors in patients with septic shock and the predictive value of related parameters for AKI.Methods Totally 256 patients with septic shock treated in our hospital from January 2015 to December 2018 were collected.The patients were divided into acute kidney injury(AKI)group and non-AKI group.The miRNA-125,IL-6,neutrophil gelatinase associated lipocalin(NGAL)and tumor necrosis factor-a(TNF-a)were compared between two groups.Multi-factor Logistic regression analysis was used to assess the variables in predicting the incidence rate.The patients in AKI group were divided into mild-AKI group(AKI stage 1-2)and severe AKI group(AKI stage 3).The factors were statistically compared between two groups.Results The levels of miRNA-125 and NGAL in AKI group were significantly higher than those in non-AKI group.The creatinine(OR 1.03,95%CI 0.88-1.36),glomerular filtration rate(OR1.23,95%CI 0.75-2.01),miRNA-125(OR 1.56,95%CI 1.02-2.10)and NGAL(OR 1.32,95%CI 0.83-1.67)were associated with AKI(P<0.05).The levels of miRNA-125,NGAL and TNF-a in severe AKI group were significantly higher than those in mild and moderate AKI group(P<0.05).The area under curve of miRNA-125 was 0.80(95%CI 0.75-0.83),the best cut-off value was 32.1,and the sensitivity and specificity were 81.5%and 76.2%.Conclusion The creatinine,glomerular filtration rate and the level of miRNA-125 and NGAL were independently associated with AKI.The level of miRNA-125 can predict the incidence of AKI.

关 键 词：miRNA-125 急性肾损伤 感染性休克 

分 类 号：R692.5[医药卫生—泌尿科学]