血清胆碱酯酶对脓毒症相关急性肾损伤患者的预测价值  

Predictive value of serum cholinesterase in patients with septic acute kidney injury

作　　者：周晓[1] 郭东晨[1] 林瑾[1] 段美丽[1] Zhou Xiao;Guo Dongchen;Lin Jin;Duan Meili(Department of Critical Care Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院重症医学科,北京100054

出　　处：《中华重症医学电子杂志》2022年第2期133-139,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：北京市临床重点专科项目卓越项目(ZYLX201802)。

摘　　要：目的评估血清胆碱酯酶(SCHE)对脓毒症相关急性肾损伤(SAKI)患者的预测价值。方法回顾性分析2018年1月至2020年12月首都医科大学附属北京友谊医院ICU收治的382例诊断为脓毒症患者的临床资料,根据是否发展为急性肾损伤将其分为SAKI组和非SAKI组。比较2组患者基线资料及临床指标,并进行多因素回归分析,绘制受试者工作特征曲线(ROC)来评价SCHE对SAKI的预测价值。结果本研究382例脓毒症患者中,195例患者出现SAKI,SAKI的发生率为51.05%。SAKI患者中SCHE水平明显低于非SAKI患者,差异有统计学意义[4.27(2.75,6.54)KU/L vs 7.70(4.58,10.41)KU/L,P<0.01]。SAKI不同亚组中,AKI 1期、2期、3期患者的SCHE水平分别为5.08(2.64,6.32)、4.69(2.75,6.67)、3.17(2.54,6.34)KU/L,不同亚组与非AKI患者[7.70(4.58,10.41)KU/L]组间比较,差异有统计学意义[克鲁斯卡尔-沃利斯H(K)=53.870,自由度=3,P=0.000]。SCHE为SAKI发生的独立保护因素(95%CI:0.753~0.856,P=0.000)。SCHE预测SAKI发生的AUC为0.716,95%CI为0.664~0.768(P<0.01)。截断值为6.70 KU/L时,SCHE预测SAKI发生的敏感度为77.9%,特异度为62.0%。结论SCHE可作为SAKI发生的预测指标,但其机制需要进一步研究。Objective To evaluate serum cholinesterase for predicting the risk of acute kidney injury in sepsis patients.Methods The adult patients with sepsis for more than 24 hours admitted to ICU from Jan 2018 to Dec 2020 were enrolled.Serum cholinesterase were collected at ICU admission.The patients were divided into different groups according to the occurrence of acute kidney injury in 24 hours.The baseline data and clinical indicators of the two groups of patients were compared,multivariate regression was performed.The ROC curve was analyzed for SCHE to assess the predictive value of sepsis related acute kidney injury for patients.Results A total of 382 patients with sepsis were enrolled.195 AKI patients were diagnosed,with a prevalence of 51.05%.SCHE in AKI group was significantly lower than that in non-AKI group[KU/L:4.27(2.75,6.54)vs 7.70(4.58,10.41),P<0.01].SCHE levels in ASKI stage 1,2 and 3 group were 5.08(2.64,6.32),4.69(2.75,6.67),3.17(2.57,6.34)KU/L,respectively,the difference were statistically significant between subgroup and non-AKI patients[7.70(4.58,10.41)KU/L][Cruskar-Wallis H(K)=53.870,degree of freedom=3,P=0.000].SCHE was an independent protection factor for SAKI.AUC of SCHE in predicting the occurrence of SAKI was 0.716,with the 95%confidence interval of 0.664-0.768(P<0.01).The cut-off value of SCHE was 6.70 KU/L,with a the sensitivity of 77.9%and specificity of 62.0%.Conclusion Serum cholinesterase can be a potential predictor of acute kidney injury in sepsis.

关 键 词：血清胆碱酯酶 急性肾损伤 脓毒症 

分 类 号：R47[医药卫生—护理学]