血清penKid、IGFBP7对重度烧伤患者急性肾损伤的预测价值  

The predictive value of serum penKid and IGFBP7 on acute kidney injury in patients with severe burns

作　　者：赵亮 李沁鹏 江涛 陈韶青 李明 Zhao Liang;Li Qinpeng;Jiang Tao;Chen Shaoqing;Li Ming(Emergency Department,Peace Hospital,Changzhi Medical College,Shanxi Province,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院急诊科,046000

出　　处：《疑难病杂志》2024年第3期340-345,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：山西省卫生健康科研课题(2019119)。

摘　　要：目的研究重度烧伤患者血清脑啡肽原A 119-159(penKid)、胰岛素样生长因子结合蛋白7(IGFBP7)水平及对急性肾损伤(AKI)的预测价值。方法选取2019年4月—2022年4月长治医学院附属和平医院急诊科收治重度烧伤患者98例为烧伤组,根据是否发生AKI分为AKI亚组(n=30)与非AKI亚组(n=68),以医院同期体检的健康人60例为健康对照组。采用酶联免疫吸附实验检测患者伤后24 h内血清penKid、IGFBP7水平;多因素Logistic回归分析重度烧伤患者AKI发生的影响因素;受试者工作特征曲线评价血清penKid、IGFBP7及二者联合预测重度烧伤患者AKI发生的价值。结果烧伤组血清penKid、IGFBP7水平均高于健康对照组(t/P=36.873/<0.001、35.841/<0.001)。AKI亚组入院24 h内急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、血肌酐、penKid、IGFBP7均高于非AKI亚组(t/P=4.405/<0.001、14.070/<0.001、12.055/<0.001、8.939/<0.001、7.827/<0.001)。随着重度烧伤患者AKI分期升高,血清penKid、IGFBP7依次升高(F/P=11.922/<0.001、17.381/<0.001)。SOFA评分、APACHEⅡ评分、血肌酐、血清penKid、IGFBP7升高是影响重度烧伤患者AKI发生的独立危险因素[OR(95%CI)=1.605(1.168~2.205)、1.765(1.233~2.526)、1.859(1.317~2.625)、1.602(1.268~2.022)、1.594(1.252~2.028)]。血清penKid、IGFBP7及二者联合预测重度烧伤发生AKI的曲线下面积(AUC)分别为0.804、0.840、0.890,二者联合预测重度烧伤患者的AUC高于单项检测(Z=4.348、3.847,P均<0.001)。结论重度烧伤患者血清penKid、IGFBP7水平升高是影响AKI发生的独立影响因素,二者联合对重度烧伤患者AKI的发生具有较高的预测价值。Objective To study the levels of serum enkephalinogen A 119-159(penKid)and insulin-like growth factor binding protein 7(IGFBP7)in patients with severe burns and the predictive value of acute kidney injury(AKI).Method Ninety-eight patients with severe burns admitted to the Emergency Department of Peace Hospital affiliated to Changzhi Medical College from April 2019 to April 2022 were selected as the burn group,and they were divided into AKI subgroups according to whether AKI occurred(n=30)and non-AKI subgroups(n=68),and 60 cases of healthy people who had medical checkups in the hospital at the same time were used as the healthy control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of serum penKid and IGFBP7 in patients within 24 h after injury;multifactorial logistic regression was used to analyze the influencing factors on the occurrence of AKI in patients with severe burns;and the value of the working characteristic curve of subjects to evaluate the prediction of the occurrence of AKI in patients with severe burns by serum penKid,IGFBP7 and the combination of the two was evaluated.Results The serum penKid and IGFBP7 levels were higher in the burn group than in the control group(t/P=36.873/<0.001,35.841/<0.001).Acute Physiology and Chronic Health Status Evaluation II scores,sequential organ failure scores,blood creatinine,penKid,and IGFBP7 were higher in the AKI subgroup than in the non-AKI subgroup within 24 h of admission(t/P=4.405/<0.001,14.070/<0.001,12.055/<0.001,8.939/<0.001,7.827/<0.001).Serum penKid and IGFBP7 were sequentially increased with increasing AKI stage in patients with severe burns(F/P=11.922/<0.001,17.381/<0.001).SOFA score,APACHE II score,blood creatinine,serum penKid,and IGFBP7 were independent risk factors affecting the development of AKI in patients with severe burns[OR(95%Cl)=1.605(1.168-2.205),1.765(1.233-2.526),1.859(1.317-2.625),1.602(1.268-2.022),1.594(1.252-2.028)].The area under the curve(AUC)of serum penKid,IGFBP7 and the combination of the two in pred

关 键 词：重度烧伤 急性肾损伤 脑啡肽原A 119-159 胰岛素样生长因子结合蛋白7 预测价值 

分 类 号：R692.6[医药卫生—泌尿科学] R644[医药卫生—外科学]