脓毒性休克患者并发AKI的影响因素及miR-21与miR-29a对预后的评估价值  

Influencing factors of AKI in patients with septic shock and the prognostic value of miR-21 and miR-29a

作　　者：郝明伟[1] 吴凤玲[1] 杨薛萍[1] 叶友胜[1] 张琳[1] HAO Ming-wei;WU Feng-ling;YANG Xue-ping;YE You-sheng;ZHANG Lin(Hefei First People′s Hospital,Hefei,Anhui 23006,China)

机构地区：[1]合肥市第一人民医院重症医学科,安徽合肥230061

出　　处：《中华医院感染学杂志》2021年第20期3041-3045,共5页Chinese Journal of Nosocomiology

基　　金：合肥市重点学科建设基金资助项目(合卫科教[2019]160号);合肥市名医工作室基金资助项目(合人才[2019]1号)。

摘　　要：目的分析脓毒性休克患者并发急性肾损伤(AKI)的影响因素,并探讨微小RNA-21(miR-21)、miR-29a对脓毒性休克并发AKI患者预后的评估价值。方法回顾性分析合肥市第一人民医院收治的80例脓毒症休克患者的临床资料,根据是否发生AKI将患者分为AKI组36例和非AKI组44例,归纳脓毒性休克患者发生AKI的影响因素。并根据脓毒性休克并发AKI患者临床结局将其分为存活患者和死亡患者,比较不同预后患者miR-21、miR-29a表达水平,分析miR-21、miR-29a对患者预后的评估价值。结果 AKI组双肾叶间动脉收缩期峰值流速(PSV)、舒张期最小流速(EDV)均低于非AKI组(P<0.05),阻力指数(RI)高于非AKI组(P<0.05)。两组平均动脉压(MAP)、急性生理与慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评分(SOFA)、氧合指数(PaO_(2)/FiO_(2))、血小板(PLT)、活化部分凝血活酶时间(APTT)、降钙素原(PCT)、C-反应蛋白(CRP)、白蛋白(Alb)、乳酸(LA)、PSV、EDV和RI差异均有统计学意义(P<0.05)。MAP、APACHEⅡ评分、PCT是脓毒性休克患者发生AKI的影响因素(P<0.05)。存活患者miR-21、miR-29a表达水平均低于死亡患者(P<0.05),miR-21、miR-29a评估脓毒性休克并发AKI患者预后不良的敏感度分别为75.00%、62.50%,特异度分别为60.00%、75.00%。结论 miR-21、miR-29a对脓毒性休克并发AKI患者预后评估具有预测价值,临床可针对影响因素采取相关措施,评估脓毒性休克并发AKI患者预后,以尽可能减少患者死亡。OBJECTIVE To analyze the influencing factors of acute kidney injury(AKI) in patients with septic shock,and to investigate the evaluation value of micro RNA-21(miR-21) and miR-29 a in the prognosis of patients with septic shock complicated with AKI.METHODS The clinical data of 80 patients with septic shock admitted to Hefei First People′s Hospital were retrospectively analyzed.According to whether AKI occurred,the patients were divided into 36 cases of AKI group and 44 cases of non-AKI group,and the influencing factors of AKI in patients with septic shock were summarized.According to the clinical outcome of septic shock complicated with AKI,the patients were divided into survival group and death group.The expression levels of miR-21 and miR-29 a in patients with different prognosis were compared,and the evaluation value of miR-21 and miR-29 a on the prognosis of patients was analyzed.RESULTS The peak systolic velocity(PSV) and the minimum end diastolic velocity(EDV) of the bilateral renal interlobar arteries in the AKI group were significantly lower than those in non-AKI group(P<0.05),while the resistive index(RI) was significantly higher than that of non-AKI group(P<0.05).There were significant differences in mean arterial pressure(MAP),acute physiological and chronic health evaluation II(APACHE II),sequential organ failure score(SOFA),oxygenation index(PaO_(2)/FiO_(2)),platelet(PLT),activated partial thromboplastin time(APTT),procalcitonin(PCT),C-reactive protein(CRP),albumin(Alb),lactic acid(LA),PSV,EDV and RI(P<0.05).MAP,APACHE II score,and PCT were the influencing factors of AKI in patients with septic shock(P<0.05).The expression levels of miR-21 and miR-29 a in the survival group were significantly lower than those in the death group(P<0.05).The sensitivities of miR-21 and miR-29 a in assessing poor prognosis of patients with septic shock complicated by AKI were 75.00% and 62.50%,and the sensitivities were 60.00% and 75.00%,respectively.CONCLUSION Both miR-21 and miR-29 a had predictive value in evaluatin

关 键 词：脓毒性休克 急性肾损伤 肾脏微循环 血流动力学 凝血功能 微小RNA-21 微小RNA-29a 

分 类 号：R459.7[医药卫生—急诊医学]