肝素结合蛋白联合降钙素原对脓毒症相关急性肾损伤死亡风险的预测价值  

Predictive value of heparin binding protein and procalcitonin for mortality risk in patients with sepsis associated acute kidney injury

作　　者：代仔怡 闫新明[1] 武卫东[3] 马天龙 朱洪伍 杨基 郭仙杰 DAI Zi-Yi;YAN Xin-Ming;WU Wei-Dong;MA Tian-Long;ZHU Hong-Wu;YANG Ji;GUO Xian-Jie(Department of Emergency Surgery,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China;Department of Emergency,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang Central Hospital,Xiangyang 441000,Hubei Province,China;Intensive Care Unit,Third Hospital of Shanxi Medical University,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院急诊外科,太原030032 [2]湖北文理学院附属医院·襄阳市中心医院:急诊科,湖北襄阳441000 [3]山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院重症医学科,太原030032

出　　处：《中华老年多器官疾病杂志》2022年第9期660-664,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：山西省重点研发计划(指南)项目(201603D321065)。

摘　　要：目的探讨血清肝素结合蛋白(HBP)联合降钙素原(PCT)对脓毒症相关急性肾损伤(SA-AKI)患者28 d死亡风险的预测价值。方法回顾性分析2020年7月至2022年2月山西白求恩医院急诊科重症监护室(ICU)收治的75例SA-AKI患者的临床资料。根据28 d转归情况将患者分为生存组(51例)和死亡组(24例),比较2组患者HBP、PCT等情况。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较。采用单因素分析和多因素logistic回归分析SA-AKI患者28 d死亡风险的独立影响因素。绘制森林图比较SA-AKI患者死亡风险的独立影响因素差异。绘制受试者工作特征(ROC)曲线评估SA-AKI患者28 d死亡危险因素的预测价值。结果死亡组和生存组HBP[115.66(96.87,255.20)和95.61(46.82,114.79)ng/mL]、PCT[29.13(26.03,111.53)和14.41(6.62,23.91)ng/mL]、血乳酸[3.90(1.75,6.93)和2.02(1.47,4.08)mmol/L]、急性生理与慢性健康状况评分[25.50(21.25,31.00)和20.00(16.00,26.25)分]、序贯器官衰竭评分[(11.46±3.68)和(8.69±3.50)分]、住院时间[9.00(5.50,19.75)和21.50(15.00,30.00)d]、使用机械通气支持治疗[24(100.%)和35(68.6%)],使用血管收缩性药物[22(91.7%)和32(62.7%)]情况比较,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,HBP(OR=1.155,95%CI 1.007~1.325)、PCT(OR=2.698,95%CI 1.003~7.254)、住院时间(OR=0.379,95%CI 0.144~0.995)是SA-AKI患者28 d预后的独立影响因素。ROC曲线结果显示,HBP预测的曲线下面积(AUC)为0.755,最佳截断值为65.815 ng/ml,灵敏度为58.3%,特异度为78.4%;PCT预测的AUC为0.871,最佳截断值为20.670 ng/ml,灵敏度为100.0%,特异度为64.7%;两者联合检测的AUC为0.903,最佳截断值为0.222 ng/ml,灵敏度为100.0%,特异度为70.6%。结论血清HBP和PCT水平升高是SA-AKI患者28 d死亡的独立危险因素。血清HBP、PCT水平对SA-AKI患者28 d死亡具有良好的预测价值,两者联合检测�Objective To investigate the predictive value of serum heparin binding protein(HBP)and procalcitonin(PCT)for 28-day mortality risk in patients with sepsis associated acute kidney injury(SA-AKI).Methods A retrospective analysis was performed of the clinical data of 75 SA-AKI patients admitted to the intensive care unit(ICU)of Emergency Department in Shanxi Bethune Hospital from July 2020 to February 2022.They were divided into the survival group(n=51)and death group(n=24)based on 28-day outcome,and the two groups were compared in HBP,PCT and other clinical data.SPSS statistics 26.0 was used for data analysis.Depending on the data type,t-test,Mann-Whitney U test,orχ^(2) test was used for comparison between groups.Univariate analysis and multivariate logistic regression were used to analyze the factors influencing the risk of death at 28 days,and forest plots were drawn to compare the independent prognostic factors.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of 28-day death risk factors.Results The two groups differed significantly in HBP[115.66(96.88,255.20)vs 95.61(46.82,114.79)ng/ml],PCT[29.13(26.03,111.53)vs 14.41(6.62,23.91)ng/ml],lactic acid[3.90(1.75,6.93)vs 2.02(1.47,4.08)mmol/L],APACHEⅡ[25.50(21.25,31.00)vs 20.00(16.00,26.25)points],SOFA[(11.46±3.68)vs(8.69±3.50)points],hospital stay[9.00(5.50,19.75)vs 21.50(15.00,30.00)d],use of mechanical ventilation support[24(100.0%)vs 35(68.6%)],and use of vasoconstrictor[22(91.7%)vs 32(62.7%)](P<0.05).Logistic regression analysis showed that HBP(OR=1.155,95%CI 1.007-1.325),PCT(OR=2.698,95%CI 1.003-7.254)and hospital stay(OR=0.379,95%CI 0.144-0.995)were independent influencing factors for death at 28 days in the SA-AKI patients.ROC curve analysis showed an area under the curve(AUC)of 0.755 for HBP with an optimal cut-off value of 65.815 ng/ml,a sensitivity of 58.3%and a specificity of 78.4%;an AUC of 0.871 for PCT with an optimal cut-off value of 20.670 ng/ml,a sensitivity of 100.0%and a specificity of 64.7%;and an AUC of

关 键 词：肝素结合蛋白 降钙素原 脓毒症 急性肾损伤 预后 

分 类 号：R631[医药卫生—外科学] R692[医药卫生—临床医学]