TNF-α及IL-1β在脓毒症性急性肾损伤中的价值及与NGAL的关系  

The value of TNF-αand IL-1βin septic acute kidney injury and their relationship with NGAL

作　　者：韩梅[1] 高梦颖[1] 郭鹏[2] 张军立[1] 王帆 梁丹 HAN Mei;GAO Mengying;GUO Peng;ZHANG Junli;WANG Fan;LIANG Dan(Emergency Department,The Second Hospital of Hebei Medical University,Xinhua,Hebei,China,050000;Department of Plastic Surgery,The Fourth Hospital of Hebei Medical University,Xinhua,Hebei,China,050000)

机构地区：[1]河北医科大学第二医院急诊科,河北新华050000 [2]河北医科大学第四医院整形外科,河北新华050000

出　　处：《分子诊断与治疗杂志》2021年第1期34-37,42,共5页Journal of Molecular Diagnostics and Therapy

基　　金：河北省重点研发计划自筹项目(172777161)。

摘　　要：目的探讨炎症因子水平对脓毒症性急性肾损伤(SI-AKI)的预测价值及即时检测NGAL对监测全身炎症反应的意义。方法共纳入脓毒症患者48例,入院后0、12、24、48、72 h监测尿量及血肌酐水平,依据KDIGO标准进行SI-AKI诊断及分期,分为:KDIGO 1、KDIGO 2、KDIGO 3及无肾损伤(non-AKI)四个时期。采集患者入院后各项临床参数,并计算APACHE Ⅱ及SOFA评分。按照预设的5个时间点留取血液标本,并应用ELISA检测血浆中NGAL、TNF-α、IL-1β和IL-10。利用AUC评价预测价值,并分析NGAL与炎症因子之间的相关性。结果伴随SI-AKI的出现,血中TNF-α及IL-1β水平均出现了升高,但均只在KDIGO 3期显著升高,与non-AKI、KDIGO 1及KDIGO 2相比较,差异具有统计学意义(P<0.05)。KDIGO 1-2期中TNF-α及IL-1β水平与non-AKI时期比较,差异无统计学意义(P>0.05)。TNF-α与IL-1β预测KDIGO 3期发生的AUC分别是0.897、0.909,显示有着良好的预测价值。TNF-α预测KDIGO 3的截断值为416.77 pg/mL,其敏感性为86.7%,特异性为73.4%;IL-1β的截断值为1766.43 pg/mL,预测的敏感性为87.8%,特异性为76.7%。在non-AKI及SI-AKI的不同时期IL-10的水平比较,差异无统计学意义(P>0.05)。NGAL与TNF-α及IL-1β均显著正相关(TNF-αr=0.949,IL-1βr=0.931,P<0.05),而与IL-10无相关性(r=0.245,P>0.05)。结论血中致炎因子TNF-α与IL-1β对重度SI-AKI有着良好的预测价值,并与NGAL密切相关,即时检测NGAL将有助于评价SI-AKI病人全身炎症反应状态,值得进一步研究评价。Objective Explore their roles in the development of sepsis-induced acute kidney injury(SI-AKI)and analyze their correlations with plasma NGAL to monitor systemic inflammatory responses.Methods A total of 48 patients with sepsis were enrolled.Urine volume and blood creatinine levels were monitored at 0,12,24,48,and 72 hours after admission.SI-AKI diagnosis and staging were performed according to KDIGO standards,and they were divided into:KDIGO 1,KDIGO 2,KDIGO 3 and four periods of non-AKI.Collect various clinical parameters after admission,and calculate APACHE Ⅱ and SOFA scores.According to the preset 5 time points,blood samples were collected,and ELISA was used to detect NGAL,TNF-α,IL-1βand IL-10 in plasma.Use AUC to evaluate the predictive value and analyze the correlation between NGAL and inflammatory factors.Results With the occurrence of SI-AKI,the levels of TNF-αand IL-1βwere significantly increased at KDIGO 3,compared with non-AKI,KDIGO 1 and KDIGO 2(P<0.05).However,no significant difference in TNF-αand IL-1βlevels in KDIGO 1 and KDIGO 2 was detected,compared with those in non-AKI(P>0.05).The area under the curve(AUC)of TNF-αand IL-1βwere 0.897 and 0.909,respectively.The cut-off value of KDIGO 3 predicted by TNF-αwas 416.77 pg/mL,with a sensitivity of 86.7%and specificity of 73.4%.The cut-off value of IL-1βwas 1766.43 pg/mL,and the sensitivity of prediction was 87.8%,and the specificity was 76.7%.There was no significant difference in the level of IL-10 between the non-AKI and SI-AKI group(P>0.05).NGAL was positively correlated with TNF-αand IL-1β(TNF-αr=0.949;IL-1βr=0.931,P<0.05),but not correlated with IL-10(r=0.245,P>0.05).Conclusion Pro-inflammatory cytokines TNF-αand IL-1βhave good predictive values for severe stage of SIAKI.Plasma NGAL has a positive correlation with TNF-αand IL-1β,which may be useful to monitor systemic inflammatory responses.

关 键 词：脓毒症 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 肿瘤坏死因子α 白细胞介素1Β 

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