巨噬细胞移动抑制因子在脓毒血症所致急性肾损伤早期诊断和预后评估中的意义  

Significance of macrophage migration inhibitory factor in the early diagnosis and prognostic assessment of sepsis-induced acute kidney injury

作　　者：丁文森 王海波 张强 王笑然 周敏 张伟 陈荣荣 DING Wen-sen;WANG Hai-bo;ZHANG Qiang;WANG Xiaoran;ZHOU Min;ZHANG Wei;CHEN Rong-rong(Department of Critical Care Medicine,Haian People's Hospital,Haian 226600,China;Department of Respiratory Medicine,Punan Branch,Renji Hospital,Shanghai Jiaotong University,Shanghai 200125,China)

机构地区：[1]海安市人民医院重症医学科,海安226600 [2]上海交通大学附属仁济医院浦南分院呼吸内科,上海200125

出　　处：《中国血液净化》2024年第5期330-333,共4页Chinese Journal of Blood Purification

基　　金：南通市基础研究和民生科技计划指导性项目(JCZ21132);上海市浦东新区卫生系统优秀青年医学人才培养计划(PWRq2022-26)。

摘　　要：目的探讨巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MIF)在脓毒血症所致急性肾损伤(acute kidney injury,AKI)早期诊断和预后评估中的意义。方法回顾性选取2017年7月─2023年5月海安市人民医院收治的脓毒血症患者为研究对象。通过酶联免疫吸附试验检测患者入住重症监护病房时的血清MIF水平。收集患者的临床、实验室检查和28天死亡资料。比较AKI组和无AKI组的指标,并通过ROC曲线明确MIF鉴别脓毒血症患者是否合并AKI以及28天内是否死亡的能力。结果纳入的121例患者中有73例(60.33%)合并AKI。AKI组患者MIF水平高于非AKI组(t=7.883,P<0.001),28天内死亡组患者MIF水平高于存活组(t=5.092,P<0.001)。多因素二元Logistic回归结果显示MIF水平(OR=3.240,95%CI:1.114~11.549,P=0.023)是脓毒血症患者合并AKI的独立危险因素。MIF鉴别脓毒血症患者是否发生AKI以及28天内死亡的曲线下面积分别为0.85和0.80。结论MIF水平升高是脓毒血症患者合并AKI和短期预后不良的危险因素,值得临床关注。Objective To explore the significance of macrophage migration inhibitory factor(MIF)in the early diagnosis and prognostic assessment of acute kidney injury(AKI)due to sepsis.Methods A total of 121 patients with sepsis admitted to our hospital from July 2017 to May 2023 were retrospectively selected.The serum MIF levels at the time of admission to the intensive care unit were detected by enzyme-linked immunosorbent assay.Patient’s clinical and laboratory measurements and 28day mortality data were collected.Parameters in both the AKI and non-AKI groups were compared,and the ability of MIF to identify septic patients with or without comorbid AKI and with or without death within 28 days was clarified by the receiveroperating characteristics(ROC)curve.Results Seventy-three(60.33%)of the included patients had combined AKI.MIF levels were significantly higher in patients in the AKI group than that in the non-AKI group[(6.82±1.58)ng/ml vs.(4.83±1.19)ng/ml,t=7.883,P<0.001],and in the 28-day mortality group than those who survived 28 days[(7.33±1.74)ng/ml vs.(5.62±1.52)ng/ml,t=5.092,P<0.001].The results of multivariate binary logistic regression showed that MIF level(OR=3.240,95%CI:1.114~11.549,P=0.023)was an independent risk factor for comorbid AKI in patients with sepsis.The area under the curve for MIF to identify AKI occurrence and 28day mortality in patients with sepsis were 0.85 and 0.80,respectively.Conclusion Elevated MIF level is a risk factor for comorbid AKI and poor short-term prognosis in patients with sepsis,which warrants clinical attention.

关 键 词：脓毒血症 巨噬细胞移动抑制因子 急性肾损伤 预后 

分 类 号：R692.5[医药卫生—泌尿科学]