蜂蜇伤患者血清降钙素原水平及其预测急性肾损伤的价值  

Procalcitonin in the patients stung by wasps and its value in predicting the onset of acute kidney injury

作　　者：冯云霞 张学鹏 陈硕 何海燕[2] Feng Yun-xia;Zhang Xue-peng;Chen Shuo;He Hai-yan(Department of Nephrology,Mianyang Central Hospital,Miaryang 621000,China)

机构地区：[1]绵阳市中心医院肾病内科,四川绵阳621000 [2]绵阳市中心医院重症医学科,四川绵阳621000

出　　处：《中国急救医学》2020年第7期610-613,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨蜂蛰伤患者血清降钙素原(PCT)水平及其预测急性肾损伤(AKI)的价值.方法回顾性分析2016年1月至2018年12月绵阳市中心医院就诊的蜂蜇伤患者,纳入入院2h内有血清PCT检测结果的患者,分析蜂蜇伤患者血清PCT水平.按有无AKI将患者分为AKI组和非AKI组,将发生AKI作为结局事件,绘制入院2h内血清PCT水平预测患者发生AKI的受试者工作特征(ROC)曲线,通过最大约登指数找出最佳截断值,并使用Logistic回归模型对协变量进行校正后,进一步分析血清PCT水平与AKI发生的关系.结果共纳入75例病例,男性42例(56.0%),平均年龄(58.03±13.92)岁,共39例发生AKI.62例(82.67%)蜂蜇伤患者血清PCT水平高于正常水平(μg/L:2.46-±6.45 vs.0.05,95%CI0.92~3.89μg/L).AKI组年龄、血清PCT水平、血肌酐(Cr)水平、血白细胞计数(WBC)、住院天数均大于非AKI组(P<0.05).AKI组伤后就诊时间大于非AKI组,但差异无统计意义(P=0.341).入院2h内血清PCT水平预测AKI的ROC曲线下面积(AUC)为0.845[95%置信区间(CI)0.757~0.933,P<0.001],0.948μg/L作为截断值时,约登指数最大,特异度91.7%,敏感度64.1%.经过Logistic回归模型对协变量进行校正后发现,入院2h内血清PCT水平高于0.948μg/L是发生AKI的独立危险因素[优势比(OR)=12.986,95%CI3.218~52.398,P<0.001].结论蜂蜇伤患者血清PCT水平高于正常水平,入院2h内血清PCT水平能较好地预测AKI的发生,入院2h内血清PCT水平大于0.948μg/L的患者较小于0.948μg/L的患者发生AKI的风险增加约13倍.Objective To investigate the levels of plasma procalcitonin(PCT)in the patients stung by wasps and to evaluate the performance of PCT levels in the first 2 h on admission in predicting the onset of acute kidney injury(AKI)in those patients.Methods Patients admitted to Mianyang central hospital from January 2016 to December 2018 who had been stung by wasps were screened.The patients who had available data of plasma PCT concentration within the first 2 h of admission were ollected,and their plasma levels of PCT would be compared with normal level.According to the onset of AKI,the patients were divided into AKI group and non-AKI group.Performance of PCT in predicting occurence of AKI was evaluated by area under the receiver operating characteristic curve(ROC).Covariates were adjusted by a Logistic regression model in order to reveal the relationship between PCT and AKI.Results 75 patients were enrolled in total,39 patients had AKI,42 patients(56%)were.male,mean age was(58.03±13.92)years.PCT levels of 62 patients were higher than normal level(μug/L:2.46±6.45 vs.0.05,95%CI 0.92-3.89μg/L).Age,PCT levels,creatinine(Cr)levels,white blood cell(WBC)counts,and length of stay in the patients with AKI were higher than those in the patients without AKI(P<0.05).Time from bite to hospital was longer in AKI group,but it was not significant(P=0.341).For PCT levels in the first 2 h of admission,the the area under ROC curve(AUC)was 0.845(95%C10.757-0.93,P<0.001).0.948μg/L was the cut-off in maximizing the Youden index,in this condition,specificity was 91.7%and sensitivity was 64.1%,Afer adjustment of covariates,PCT levels higher than 0.948μg/L in the first 2 h was independently associated with AKI[odds ratio(OR)=12.986,95%CI 3.218-52.398,P<0.001].Concusion PCT levels in the patients stung by wasps were higher than the normal level.PCT levels in the first2 h of admission had good performance in predieting the occurrence of AKI.The risk for AKI in the patients with PCT level higher than 0.948 ug/L was almost 13 times higher than

关 键 词：蜂蜇伤 降钙素原(PCT) 急性肾损伤(AKI) 

分 类 号：R646[医药卫生—外科学] R692[医药卫生—临床医学]