血清白细胞介素-35联合Klotho蛋白对脓毒症急性肾损伤诊断及预后的预测价值  

Diagnostic and prognostic assessment value of serum interlukin-35 combined with Klotho protein in acute kidney injury with sepsis

作　　者：张志敏 王翔 王晶 王利华 Zhang Zhimin;Wang Xiang;Wang Jing;Wang Lihua(Department of Critical Care Medicine,Affiliated Dongfeng Hospital,Hubei University of Medicine,HubeiShiyan 442000,China;Department of Laboratory,Affiliated Dongfeng Hospital,Hubei University of Medicine,Hubei Shiyan 442000,China)

机构地区：[1]湖北医药学院附属东风医院重症医学科,湖北十堰442000 [2]湖北医药学院附属东风医院检验科,湖北十堰442000

出　　处：《中国医师进修杂志》2020年第6期521-526,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨检测血清白细胞介素(IL)-35和Klotho蛋白水平在脓毒症患者急性肾损伤(AKI)的诊断和评估预后方面的价值。方法选择2017年1月至2019年5月湖北医药学院附属东风医院诊治的175例脓毒症患者,按照改善全球肾脏病预后组织(KDIGO)标准将患者分为AKI组(86例)及非AKI组(89例),根据AKI的临床结局进行预后分组。比较不同分组患者的血肌酐(Scr)、血清IL-35和Klotho蛋白水平,绘制IL-35、Klotho蛋白、IL-35联合Klotho蛋白的受试者工作特征(ROC)曲线,评价IL-35、Klotho蛋白、IL-35联合Klotho蛋白对脓毒症AKI的诊断及预后的预测价值。结果AKI组Scr水平较非AKI组高[(264.43±67.86)μmol/L比(64.76±22.41)μmol/L],AKI组IL-35、Klotho蛋白水平较非AKI组低[(69.37±28.15)ng/L比(94.74±35.32)ng/L、(142.31±32.55)ng/L比(256.23±36.25)ng/L],差异有统计学意义(P<0.05)。发生AKI的患者中,1期AKI、未实施持续肾脏替代治疗、观察终点肾功能恢复患者Scr水平较低,IL-35、Klotho蛋白水平较高,与2~3期AKI、实施持续肾脏替代治疗、观察终点肾功能未恢复患者比较差异有统计学意义(P<0.05)。IL-35联合Klotho蛋白水平预测AKI及AKI分期的曲线下面积(AUC)分别为0.918、0.899,IL-35联合Klotho蛋白水平预测AKI患者是否进行持续肾脏替代治疗及肾功能恢复情况的AUC分别为0.954、0.950,均高于单一指标,差异有统计学意义(P<0.05)。结论IL-35、Klotho蛋白水平是诊断脓毒症患者是否发生AKI及判断预后的良好生物标志物,两者联合检测可进一步提高预测效能。Objective To investigate the diagnostic and prognostic assessment value of serum interlukin(IL)-35 combined with Klotho protein in acute kidney injury(AKI)with sepsis.Methods One hundred and seventy-five patients with sepsis admitted to Affliated Dongfeng Hospital,Hubei University of Medicine from January 2017 to May 2019 were enrolled and divide into AKI group(86 cases)and non-AKI group(89 cases)according to the standard of Kidney Disease Improving Global Outcomes(KIDGO)and groups were divided based on the prognosis of AKI clinical outcome.The levels of serum creatine(Scr),serum IL-35 and Klotho protein of different groups were compared.The receiver operating characteristic curve(ROC curve)of serum IL-35,Klotho protein and IL-35 combined with Klotho protein were drawn,and the value of serum IL-35,Klotho protein and IL-35 combined with Klotho protein in the diagnosis and prognosis prediction of sepsis AKI were evaluated.Results The level of Scr in the AKI group was higher than that in the non-AKI group[(264.43±67.86)μmol/L vs.(64.76±22.41)μmol/L],while the levels of IL-35 and Klotho protein were lower than those in the non-AKI group[(69.37±28.15)ng/L vs.(94.74±35.32)ng/L,(142.31±32.55)ng/L vs.(256.23±36.25)ng/L],and the differences were statistically significant(P<0.05).In the patients that had AKI,those who were in AKI phase one,without continuous renal dialysis or whose renal functions recovered at the end point had relatively lower Scr level and higher IL-35 and Klotho protein levels,and the differences were statistically significant(P<0.05).The area under the curve(AUC)of AKI and staged AKI predicted by IL-35 combined with Klotho protein levels were 0.918 and 0.899 respectively,and the area under the curve(AUC)of continuous renal replacement therapy needed in the AKI patients and their renal function recovery predicted by IL-35 combined with Klotho protein levels were 0.954 and 0.950 respectively,all higher than the single indicator,and the differences were statistically significant(P<0.05).Conclusion

关 键 词：脓毒症 急性肾功能不全 白细胞介素-35 KLOTHO蛋白 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]