肝素结合蛋白联合白介素-6对持续性脓毒症急性肾损伤的预测价值  

Predictive value of heparin-binding protein combined with interleukin-6 in different subtypes of sepsis associated acute kidney injury

作　　者：金仁华 李静[1] 沈骁 孙加奎[1] 穆心苇[1] JIN Renhua;LI Jing;SHEN Xiao;SUN Jiakui;MU Xinwei(Department of Critical Care Medicine,Nanjing First Hospital,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing,210000,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)重症医学科,南京210000

出　　处：《临床急诊杂志》2023年第3期119-125,共7页Journal of Clinical Emergency

摘　　要：目的:探讨肝素结合蛋白(HBP)联合白介素-6(IL-6)对持续性脓毒症急性肾损伤(SA-AKI)的预测价值。方法:回顾性选取2019年12月—2021年11月期间在南京医科大学附属南京医院重症医学科收治的符合Sepsis 3.0诊断标准的脓毒症患者,根据KIDGO标准将患者分为对照组(脓毒症无AKI组)及SA-AKI组,再根据急性疾病质量倡议(ADQI)标准将SA-AKI组患者分为一过性SA-AKI组和持续性SA-AKI组。分析比较3组患者基本临床资料以及预后情况。应用受试者工作特征(ROC)曲线分析HBP、IL-6及HBP联合IL-6对SA-AKI不同亚型尤其是持续性SA-AKI的预测价值。结果:共有202例脓毒症患者纳入分析,其中108例患者(53.4%)发生SA-AKI,53例(26.2%)为一过性SA-AKI,55例(27.2%)为持续性SA-AKI。在SA-AKI患者中,与一过性SA-AKI相比,持续性SA-AKI患者的炎症反应更重,HBP、IL-6、PCT、CRP水平更高。HBP、IL-6对持续性SA-AKI均有预测价值,ROC曲线下面积分别为0.763(95%CI:0.677~0.849)、0.782(95%CI:0.699~0.866)。HBP联合IL-6可提高对持续性SA-AKI的预测价值,ROC曲线下面积为0.801(95%CI:0.722~0.880)。结论:HBP、IL-6均对持续性SA-AKI有较高的预测价值,HBP联合IL-6可提高对持续性SA-AKI的预测价值。Objective: To investigate the predictive value of heparin-binding protein(HBP) combined with interleukin-6(IL-6) in persistent sepsis associated acute kidney injury(AKI). Methods: This retrospective study enrolled adult patients with confirmed diagnostic criteria of Sepsis 3.0 and admitting to Department of Critical Care Medicine of our hospital, during the period from December 2019 to November 2021. Patients were divided into control group(sepsis without AKI) and SA-AKI group according to KIDGO criteria, and then SA-AKI group was divided into transient SA-AKI group and persistent SA-AKI group according to ADQI criteria. The baseline clinical data and prognosis of the patients were analyzed and compared. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of HBP, IL-6 and HBP combined with IL-6 for different subtypes of SA-AKI. Results: Of the 202 sepsis patients, 108(53.4%) developed AKI, 53(26.2%) had transient AKI, and 55(27.2%) had persistent AKI. In patients with SA-AKI, persistent SA-AKI had severer inflammatory response and higher levels of HBP, IL-6, PCT, CRP compared with transient SA-AKI. HBP and IL-6 had predictive value for persistent SA-AKI, and the area under ROC curve(AUC) was 0.763(95%CI: 0.677-0.849) and 0.782(95%CI: 0.699-0.866) respectively. HBP combined with IL-6 could improve the predictive value for persistent SA-AKI, and the AUC was 0.801(95%CI: 0.722-0.880). Conclusion: HBP and IL-6 had high predictive value for persistent SA-AKI, and HBP combined with IL-6 could improve the predictive value for persistent SA-AKI.

关 键 词：肝素结合蛋白 白介素-6 脓毒症急性肾损伤 持续性急性肾损伤 预测 

分 类 号：R631.2[医药卫生—外科学]