血清心型脂肪酸结合蛋白对脓毒症患者并发急性肾损伤的预测价值  

The prognostic value of serum heart-type fatty acid-binding protein in sepsis patients with acute kidney injury

作　　者：曹臻[1] 倪春华[1] CAO Zhen;NI Chun-hua(Department of Critical Care Medicine,Kunshan Hospital Affiliated to Jiangsu University,Kunshan 215300,China)

机构地区：[1]江苏大学附属昆山医院重症医学科,215300

出　　处：《天津医药》2020年第11期1091-1095,共5页Tianjin Medical Journal

基　　金：昆山市社会发展科技专项课题(KS18060)。

摘　　要：目的探讨血清心型脂肪酸结合蛋白(H-FABP)对脓毒症患者并发急性肾损伤(AKI)的预测价值。方法采用前瞻性研究设计,选取江苏大学附属昆山医院重症医学科2018年1月—2019年12月收治的135例脓毒症患者为研究对象。根据患者住院期间是否出现AKI,分为脓毒症非AKI组(75例)与脓毒症AKI组(60例)。入组患者均于确诊24 h内空腹抽取静脉血5 mL,通过酶联免疫吸附测定试剂盒检测血H-FABP。收集患者年龄、性别、序贯性器官功能衰竭评分(SOFA)、氧合指数[p(O2)/FiO2],既往病史(高血压、糖尿病、冠心病),生命体征(呼吸频率、心率、体温、平均动脉压),实验室指标[白细胞、血小板、尿素氮、血肌酐、C反应蛋白、心肌肌钙蛋白I(cTnI)、N-端脑利钠肽前体(NT-proBNP)],辅助手段[血管升压药、气管插管、连续肾脏替代疗法(CRRT)]等资料。多因素Logistic回归分析评价脓毒症患者并发AKI的独立危险因素。Spearman秩相关分析血清H-FABP与C反应蛋白、cTnI、NT-proBNP和SOFA评分的相关性,绘制上述5种指标预测AKI的受试者工作特征(ROC)曲线判断其预测价值,并比较曲线下面积(AUC)。结果(1)脓毒症AKI组年龄、SOFA评分、C反应蛋白、cTnI、NT-proBNP、H-FABP水平及使用血管升压药和CRRT的比例均高于脓毒症非AKI组(均P<0.01)。(2)H-FABP预测脓毒症患者并发AKI的AUC[0.813(0.737~0.875)]高于C反应蛋白[0.624(0.537~0.706)]、cTnI[0.641(0.554~0.722)]、NT-proBNP[0.660(0.574~0.739)],但与SOFA评分[0.834(0.760~0.892)]差异无统计学意义(P>0.05)。(3)NT-proBNP≥3367 ng/L、H-FABP≥6.2μg/L及SOFA评分≥4分是脓毒症患者并发AKI的独立危险因素。(4)H-FABP与C反应蛋白(rs=0.663)、cTnI(rs=0.688)、NTproBNP(rs=0.727)、SOFA(rs=0.490)呈正相关(均P<0.01)。结论H-FABP或可成为脓毒症患者并发AKI的有效预测指标,其水平升高提示脓毒症患者并发AKI的风险较高。Objective To explore the predictive value of serum heart-type fatty acid binding protein(H-FABP)level for acute kidney injury(AKI)in patients with sepsis.Methods A prospective research design method was used,and 135 patients with sepsis from the Department of Intensive Medicine of Kunshan Hospital Affiliated to Jiangsu University from January 2018 to December 2019 were selected.According to whether AKI occurred during hospitalization,patients were divided into non-AKI with sepsis group(75 cases)and AKI with sepsis group(60 cases).All patients were drawn 5ml of fasting venous blood within 24 hours after diagnosis,and the blood H-FABP was detected by enzyme-linked immunosorbent assay kit.Data of the age,gender,sequential organ failure score(SOFA),oxygenation index[p(O2)/FiO2],past medical history(hypertension,diabetes and coronary heart disease),vital signs(respiratory rate,heart rate,body temperature and mean arterial pressure),laboratory indicators[white blood cells,platelets,urea nitrogen,blood creatinine,C-reactive protein,cardiac troponin I(cTnI),N-terminal pro-brain-type natriuretic peptide(NT-proBNP)]and auxiliary means[(vascular rise compression,tracheal intubation,continuous renal replacement therapy(CRRT)]were collected.Multivariate Logistic regression analysis was used to evaluate the independent risk factors for sepsis patients with AKI.Spearman correlation analysis showed the correlation between serum H-FABP and C-reactive protein,cTnI,NT-proBNP and SOFA score indicators.The receiver operating characteristic(ROC)curves of the above five indicators were drawn to predict the predictive value of AKI,and the areas under the curve(AUC)were compared.Results(1)The data of the age,SOFA score,C-reactive protein,cTnI,NT-proBNP,H-FABP levels and the use of vasopressors and CRRT were significantly higher in the sepsis with AKI group than those in the sepsis with non-AKI group(all P<0.01).(2)The AUC predicted by H-FABP(0.813,95%CI:0.737-0.875)in sepsis patients with AKI was higher than that of C-reactive protein(0.

关 键 词：脓毒症 急性肾损伤 预后 危险因素 脂肪酸结合蛋白质类 心型脂肪酸结合蛋白 

分 类 号：R631.2[医药卫生—外科学]