血浆可溶性白细胞分化抗原14亚型对急性肾损伤患者发生脓毒症的早期诊断价值  

Value of plasma the soluble CD14 subtype in early diagnosis of sepsis patients with acute renal injury

作　　者：沈雯雯 刘琴[1] 黄凯[1] 姜小敢[2] 陈尚华 SHEN Wenwen;LIU Qin;HUANG Kai;JIANG Xiaogan;CHEN Shanghua(Department of Critical Care Medicine,Wuhu Hospital Affiliated to East China Normal University,Wuhu,Anhui,241000;Department of Critical Care Medicine,Yijishan Hospital Affiliated to Wannan Medical College,Wuhu,Anhui,241000)

机构地区：[1]华东师范大学附属芜湖医院重症医学科,安徽芜湖241000 [2]皖南医学院附属弋矶山医院重症医学科,安徽芜湖241000

出　　处：《实用临床医药杂志》2024年第10期46-50,共5页Journal of Clinical Medicine in Practice

基　　金：安徽省教育厅重点项目(KJ2016A718)。

摘　　要：目的评估血浆可溶性白细胞分化抗原14亚型(sCD14-ST,又称Presepsin)对急性肾损伤(AKI)患者发生脓毒症的早期诊断价值。方法采用前瞻性研究方法选取2021年1月—2022年12月华东师范大学附属芜湖医院重症医学科符合AKI诊断标准的患者110例,根据2012年改善全球肾脏病预后组织(KDIGO)定义的分期标准,将入选患者分为AKI 1期组(34例)、AKI 2期组(36例)和AKI 3期组(40例),选择同期53例非AKI患者为对照组。不同组别患者再根据有无脓毒症进一步分为脓毒症组和非脓毒症组。记录所有研究对象血浆Presepsin水平,绘制受试者工作特征(ROC)曲线评估Presepsin对AKI患者早期脓毒症的诊断价值,采用约登指数找出最佳临界值。结果脓毒症组Presepsin水平均高于非脓毒症组,差异有统计学意义(P<0.05)。在非脓毒症患者中,随着肾功能损伤的加重,Presepsin水平呈逐渐上升趋势(P<0.05)。AKI 3期组患者Presepsin水平均高于非AKI组,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,AKI 1期组、AKI 2期组和AKI 3期组Presepsin水平诊断脓毒症的曲线下面积(AUC)均小于非AKI组,但差异无统计学意义(P>0.05)。结论Presepsin可以作为AKI患者脓毒症早期诊断的标志物,但应根据肾功能损害严重程度采用不同阈值。Objective To evaluate the diagnostic value of plasma the soluble CD14 subtype(sCD14-ST,renamed as presepsin)in early diagnosis of sepsis patients with acute kidney injury(AKI).Methods A total of 110 patients with AKI in intensive care unit(ICU)of Wuhu Hospital Affiliated to East China Normal University from January 2021 to December 2022 were prospectively selected.The patients were divided into AKI stage 1 group(n=34),AKI stage 2 group(n=36)and AKI stage 3 group(n=40)according to the staging criteria defined byKidney Disease:Improving Global Outcomes(KDIGO)in 2012,and 53 non-AKI patients in the same period were selected as the control group.The patients were further divided into non-sepsis group and sepsis group according to whether combined sepsis or not.Plasma Presepsin levels were recorded in all the patients.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of Presepsin inearly sepsis in AKI patients,and the optimal cutoff value was found using Jorden index.Results The level of Presepsin in the sepsis group was higher than that in non-sepsis group(P<0.05).In non-sepsis patients,the level of Presepsin increased gradually with the aggravation of renal function injury(P<0.05).The level of Presepsin in stage 3 AKI group was higher than that in non-AKI group(P<0.01).ROC curve analysis results showed that thearea under the curve(AUC)of Presepsin level for diagnosing sepsis in stage 1 AKI group,stage 2 AKI group and stage 3 AKI group was smaller than that in non-AKI group(P>0.05).Conclusion Presepsin can be used as a marker for early diagnosis of sepsis in AKI patients,but different thresholds should be used according to the severity of renal impairment.

关 键 词：Presepsin 脓毒症 急性肾损伤 早期诊断 

分 类 号：R692.5[医药卫生—泌尿科学] R446.11[医药卫生—外科学] R319[医药卫生—临床医学]