血清肌红蛋白联合乳酸脱氢酶在重症中暑横纹肌溶解症所致急性肾损伤中的诊断价值  

Diagnostic value of serum myoglobin combined with lactate dehydrogenase in acute kidney injury caused by severe heatstroke rhabdomyolysis

作　　者：金子琦 唐波 刘斌[1] 左骑 肖宝 段岚 吴章宏 Jin Ziqi;Tang Bo;Liu Bin;Zuo Qi;Xiao Bao;Duan Lan;Wu Zhanghong(Emergency Department of Changsha First Hospital;Critical Care Medicine Department,The Second People's Hospital of Hunan Province;Critical Care Medicine Department of Changsha First Hospital,Changsha,China)

机构地区：[1]中南大学湘雅医学院附属长沙医院(长沙市第一医院)急诊科 [2]湖南省脑科医院(湖南省第二人民医院)重症医学科 [3]中南大学湘雅医学院附属长沙医院(长沙市第一医院)重症医学科

出　　处：《实用休克杂志（中英文）》2024年第1期26-30,共5页Journal of Practical Shock

基　　金：长沙市自然科学基金(项目编号:Kq2202010)。

摘　　要：目的探讨血清肌红蛋白(Mb)联合乳酸脱氢酶(LDH)对重症中暑横纹肌溶解症(RM)所致急性肾损伤(AKI)的诊断价值。方法回顾性收集2020年6月至2022年10月本院收治的重症中暑RM患者58例的临床资料。根据是否发生AKI将患者分为非AKI组和AKI组。比较两组患者的实验室指标,观察影响AKI发生的危险因素。采用ROC分析血清指标对AKI的预测效能。结果AKI组肌酸激酶、Mb、LDH、肌酐(Scr)、尿素氮均高于非AKI组(P<0.05)。Mb、LDH、Scr均是影响重症中暑RM患者发生AKI的相关因素(P<0.05)。重症中暑RM伴发AKI患者血清Mb、LDH水平与Scr均呈正相关(r=0.6772;r=0.6816,P<0.05)。血清Mb水平在预测重症中暑RM患者发生AKI时的AUC为0.6692(95%CI:0.5253~0.8131),当约登指数为0.3156时,敏感度为0.4545,特异性为0.8611;血清LDH水平在预测重症中暑RM患者发生AKI时的AUC为0.8277(95%CI:0.7182~0.9371),当约登指数为0.5960时,敏感度为0.8182,特异性为0.7778。血清Mb联合LDH水平在预测重症中暑RM患者发生AKI时的AUC为0.9116(95%CI:0.8219~1.001),当约登指数为0.7878时,敏感度为0.9545,特异性为0.8333。结论血清Mb、LDH水平在重症中暑RM所致AKI患者中有所提高,血清Mb联合LDH对重症中暑RM患者发生AKI具有良好的预测意义。Objective To explore the diagnostic value of serum myoglobin(Mb)combined with lactate dehydrogenase(LDH)in acute kidney injury(AKI)caused by severe heatstroke rhabdomyolysis(RM).Methods The clinical data of 58 RM patients with severe heatstroke admitted to our hospital from June 2020 to October 2022 were retrospectively collected.Patients were divided into non-AKI group and AKI group according to whether AKI occurred or not.The laboratory indexes of the two groups were compared and the risk factors affecting the occurrence of AKI were observed.ROC was used to analyze the predictive efficacy of serum indicators for AKI.Results Creatine kinase,Mb,LDH,creatinine(Scr)and blood urea nitrogen in AKI group were higher than those in non-AKI group(P<0.05).Mb,LDH and Scr were all related factors affecting AKI in RM patients with severe heatstroke(P<0.05).Serum Mb and LDH levels in RM patients with severe heatstroke complicated with AKI are positively correlated with Scr(r=0.6772;r=0.6816,P<0.05.The AUC of serum Mb levels in predicting AKI in RM patients with severe heatstroke was 0.6692(95%CI:0.5253~0.8131),and when the Youden index is 0.3156,the sensitivity was 0.4545 and the specificity was 0.8611;The AUC of serum LDH level in predicting AKI in RM patients with severe heatstroke was 0.8277(95%CI:0.7182~0.9371),and when the Youden index was 0.5960,the sensitivity was 0.8182 and the specificity was 0.7778.The AUC of serum Mb combined with LDH level in predicting AKI in RM patients with severe heatstroke was 0.9116(95%CI:0.8219~1.001),and when the Youden index was 0.7878,the sensitivity was 0.9545 and the specificity was 0.8333.Conclusions The levels of serum Mb and LDH are increased in patients with AKI caused by RM with severe heatstroke,and serum Mb combined with LDH has a good predictive significance for AKI in RM patients with severe heatstroke.

关 键 词：肌红蛋白 乳酸脱氢酶 急性肾损伤 横纹肌溶解症 重症中暑 

分 类 号：R594.12[医药卫生—内科学] R692[医药卫生—临床医学]