α1抗胰蛋白酶与脓毒症患者发生急性肾损伤的关系及其预测价值  

Correlation of both serum and urine α1-antitrypsin with acute kidney injury and their early predictive values in sepsis patients

作　　者：陶静[1] 方晶晶[1] 厉旭光[1] 殷颖杰[1] 黄钦 盖磊 颜碧清[1] Jing Tao;Jing-jing Fang;Xu-guang Li;Ying-jie Yin;Qin Huang;Lei Gai;Bi-qing Yan(Department of ICU,the Affiliated Hospital of Medicine School,Ningbo University,Ningbo,Zhejiang 315020,China)

机构地区：[1]宁波大学医学院附属医院重症医学科,浙江宁波315020

出　　处：《中国现代医学杂志》2020年第10期27-32,共6页China Journal of Modern Medicine

基　　金：宁波市科技计划项目(No:2013C50043)。

摘　　要：目的探讨α1抗胰蛋白酶(α1-AT)与脓毒症患者急性肾损伤(AKI)发生的关系及其预测价值。方法选取2017年9月-2019年10月在宁波大学医学院附属医院重症医学科住院的脓毒症患者90例。28例AKI患者作为AKI组,其余62例患者未合并AKI作为非AKI组。连续监测患者7 d血清和尿α1-AT,并绘制受试者工作特征(ROC)曲线分析AKI确诊前48和24 h及当日对脓毒症患者发生AKI的预警或诊断价值。结果①与非AKI患者入组当日数据比较,AKI组患者AKI确诊前48和24 h及确诊当日血清α1-AT含量降低(P <0.05),而尿α1-AT含量升高(P <0.05)。②经ROC曲线分析,AKI确诊前48和24 h尿α1-AT对AKI的预警效能高于血清α1-AT(P <0.05)。③多因素非条件一般Logistic回归分析结果显示,尿α1-AT是AKI发生的独立影响因素[OR^^]=1.813(95% CI:1.230,2.974),P=0.001]。结论脓毒症合并AKI患者血清α1-AT含量升高,而尿α1-AT含量降低,对AKI发生具有早期预警和诊断效能,且尿α1-AT是AKI发生的独立影响因素。Objective To analyzed the correlation of both serum and urineα1-antitrypsin(α1-AT)with acute kidney injury(AKI)and their early predictive values in sepsis patients.Methods A total of 90 sepsis patients in our hospital were selected from september 2017 to October 2019 and divided into AKI group with 28 AKI patients and non-AKI group with 62 patients without AKI.Serum and urineα1-AT levels were continuously determined for 7days.The predict or diagnosis of serum and urineα1-AT levels at the day when patients had been diagnosed as AKI or 48h and 24 h before that were analyzed by receiver operating characteristic(ROC)curve.Results①The serumα1-AT levels in AKI group at the day when patients had been diagnosed as AKI or 48 h and 24 h before that were all lower than those levels in non-AKI group(P<0.05);while the urineα1-AT levels in AKI group were all higher than those levels in non-AKI group(P<0.05).②The predictive value of urineα1-AT 48 h and 24 h before AKI diagnosis were higher than serumα1-AT(P<0.05).③Multivariate Logistic regression analysis results showed that urineα1-AT was the independent factor of AKI[OR^^=1.81(95%CI:1.23,2.97),P=0.001).Conclusion Serumα1-AT level in sepsis-AKI patients increased,but urineα1-AT level declines,which may be the early predictive or diagnostic factors of AKI.And the urineα1-AT may be the independent risk factor for AKI.

关 键 词：脓毒症 肾疾病 Α1抗胰蛋白酶 回归分析 

分 类 号：R589.9[医药卫生—内分泌]