GLUT-4对肝移植受者发生ICU获得性衰弱的预测价值  

Predictive value of glucose transporter type 4 for intensive care unit acquired weakness in liver transplantation recipients

作　　者：王胤佳[1] 马继韬[1] 张睿[1] 李立[1] Wang Yinjia;Ma Jitao;Zhang Rui;Li Li(Department of Intensive Care Unit,The First People's Hospital of Kunming,Affiliated Calmette Hospital of Kunming Medical University,Kunming 650224,China)

机构地区：[1]昆明市第一人民医院,昆明医科大学附属甘美医院重症医学科,昆明650224

出　　处：《中华器官移植杂志》2022年第9期525-529,共5页Chinese Journal of Organ Transplantation

基　　金：云南省科技厅科技计划项目昆医联合专项(202001AY070001-268)。

摘　　要：目的寻找对肝移植受者术后早期发生重症监护室获得性衰弱(intensive care unit acquired weakness,ICUAW)有诊断价值的生物标记物。方法前瞻性纳入2017年9月至2019年8月期间收治的昆明市第一人民医院肝移植受者共62例,移植术后使用相同的免疫抑制方案治疗。术后入ICU时留取血液标本进行腺苷酸活化蛋白激酶-α(AMPK-α)、葡萄糖转运子-4(GLUT-4)的检测,采集临床和生化数据。移植受者清醒配合时使用医学研究委员会(Medical Research Council,MRC)评分表进行肌力检测并评分,<48分诊断存在ICUAW,据此将62例受者分为ICUAW组(17例)和非ICUAW组(45例),对比两组受者年龄、性别、机械通气时间、ICU住院时间、血氧分压、收缩压、中心静脉压(CRP)、血糖、总胆红素、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(γ-GGT)、血尿素氮、血肌酐和AMPK-α、GLUT-4是否存在差异。使用受试者工作特征曲线(receiver operator characteristic curve,ROC)及曲线下面积(area under the curve,AUC)评价AMPK-α和GLUT-4对ICUAW的预测价值。结果62例肝移植受者中有17例诊断ICUAW,占总受者数的27.42%。ICUAW组受者机械通气时间较长(27 h比10 h,P<0.05),ICU住院时间较长(4 d比3 d,P<0.05)。ICUAW组受者与非ICUAW组受者AMPK-α比较,差异无统计学意义[(1.01±2.43)U/ml比(1.74±4.24)U/ml,95%CI:-2.92~1.45,P>0.05],GLUT-4在ICUAW受者中表达下降[(137.86±127.87)ng/L比(419.15±267.68)ng/L,95%CI:-417.13~-145.45,P<0.05]。GLUT-4 ROC曲线提示对ICUAW的发生有一定的阴性预测价值:AUC为0.88,SE为0.05,P<0.05,95%CI:0.78~0.98。结论ICUAW受者机械通气时间和ICU住院时间较长。GLUT-4的监测对肝移植受者发生ICUAW有一定的预测价值,GLUT-4升高受者出现ICUAW的几率较低。临床工作中可以通过测定GLUT-4的血清浓度来指导ICUAW的诊断和治疗。Objective To seek the biomarkers of diagnostic value for an early postoperative onset of intensive care unit acquired weakness(ICUAW)in liver transplant(LT)recipients.Methods Between September 2017 and August 2019,A total of 62 consecutive allogeneic orthotopic LT liver transplantation recipients at The First People's Hospital of Kunming between September 2017 and August 2019 are prospectively reviewedenrolled in this study.Upon After entering ICU,blood samples are assayed taken for adenosine 5'-monophosphate-activated protein kinase alpha(AMPK-α)、and glucose transporter type 4(GLUT-4)test.Clinical and bBiochemical specimens are collected.When transplant recipients are during awake and cooperative hours.Their muscle strength is recordedexamined.The score table of Medical Research Council(MRC)is utilized sed as the diagnostic standard of ICUAW.And ICUAW is diagnosed with<48 points.Based on this,62 subjects are divided into two groups of ICUAW group(17 cases)and non-ICUAW group(45 cases).The age,sex,mechanical ventilation time,ICU hospitalization time,partial blood oxygen pressure,systolic blood pressure,central venous pressure(CRP),blood glucose,total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-Glutamyl transpeptidase(γ-GGT),blood urea nitrogen,blood creatinine and levels of AMPK-αand GLUT-4 are compared between patients in ICUAW group and non-ICUAW two groups.and levels of AMPK-αand GLUT-4 were compared between patients in ICUAW group and non-ICUAW two groups.The powers of AMPK-αAnd and GLUT-4 in predicting ICUAW was were evaluated by receiver operating characteristic curve(ROC)and area under the curve(AUC).Differences with P<0.05 is deemed as significant.Results ICUAW is diagnosed in 17/62(27.42%)LT recipients.ICUAW patients had longer mechanical ventilation time(27 vs.10h,P<0.05)and extended ICU hospitalization time(4 vs.3d,P<0.05).No significant inter-group difference existed in AMPK-α(1.01±2.43 vs.1.74±4.24 units/ml,95%CI:-2.92~1.45,P>0.05).And the expression of GLUT-4

关 键 词：肝移植 重症监护室 预测 

分 类 号：R657.3[医药卫生—外科学]