脓毒症患者入重症监护室时血尿酸水平与微炎症状态的相关性及对肾损伤的预测  

Correlation of serum uric acid level with microinflammatory status and prediction of renal injury in patients with sepsis admitted to intensive care unit

作　　者：张道为 丁莉 朱学专 ZHANG Daowei;DING Li;ZHU Xuezhuan(Department of Critical Care Medicine,Taizhou People's Hospital,Taizhou,Jiangsu,225300,China;Department of Emergency,Taizhou People's Hospital;Department of Critical Care Medicine,Lianshui County People's Hospital)

机构地区：[1]泰州市人民医院重症医学科,江苏泰州225300 [2]泰州市人民医院急诊科 [3]涟水县人民医院重症医学科

出　　处：《临床急诊杂志》2024年第9期478-484,共7页Journal of Clinical Emergency

摘　　要：目的探究脓毒症患者入重症监护室(intensive care unit,ICU)时血尿酸(uric acid,UA)水平与微炎症状态的相关性及对急性肾损伤(acute kidney injury,AKI)的预测价值。方法选择2021年8月—2023年11月本院ICU收治的脓毒症患者(210例)为研究对象;根据AKI诊断标准,分为AKI组(134例)和非AKI组(76例)。对比分析2组患者的临床资料,包括年龄、性别、入ICU血生化指标等。调整混杂因素后,采用多元线性回归(MLR)模型分析UA与hs-CRP、IL-6的相关性。危险因素采用多因素logistic回归模型进行分析并构建预测模型;采用拟合优度检验预测模型。采用受试者工作特征(ROC)曲线评估模型的预测效能。采用非条件logistic回归模型和Andersson等编制的计算表分析交互作用。采用限制性立方样条(RCS)模型评估UA和AKI发生OR值间的关系。结果hs-CRP、IL-6与UA均呈正相关(P<0.05),调整混杂因素后(模型2)仍具有显著相关性(P<0.05)。与非AKI组相比,AKI组患者的血管活性药物、机械通气、肾脏替代治疗、脓毒症休克、院内死亡的患者比例以及ICU住院时间均更高(P<0.05),总住院时间更短(P<0.05)。多因素logistic回归分析中,若纳入UA、hs-CRP、IL-6,则UA、APACHEⅡ评分、PCT、BUN、钾离子、hs-CRP、IL-6,均为AKI发生的独立影响因素(P<0.05)。ROC曲线分析结果显示,模型1(不含UA、hs-CRP、IL-6)和2(包含UA、hs-CRP、IL-6)预测AKI发生的AUC分别为0.828(95%CI:0.771~0.890)和0.854(95%CI:0.782~0.913)。拟合优度检验结果显示,预测模型2拟合优度理想(P=0.596)。交互作用分析结果显示,hs-CRP(>12.30 mg/L)、IL-6(>13.78 pg/mL)与UA(>435.43μmol/L)均存在相加交互作用,其中2个因素共同存在时重度AKI风险更高(OR值分别为3.148和4.278)。RCS模型分析结果显示,UA与AKI风险存在非线性关系(非线性检验P<0.001)。结论hs-CRP、IL-6与UA均呈正相关,且对于重度AKI两两之间存在相加交互作用。UA为AKI发生的独�Objective To explore the correlation between uric acid (UA) level and microinflammatory status in patients with sepsis admitted to intensive care unit (ICU) and its predictive value for acute kidney injury (AKI).Methods Sepsis patients(n=210) admitted to the ICU of our hospital from August 2021 to November 2023 were selected as the research subjects. According to AKI diagnostic criteria, they were divided into AKI group(n=134) and non AKI group(n=76). Clinical data of two groups of patients were compared and analyzed, including age, gender, and blood biochemical indicators upon admission to the ICU. After adjusting for confounding factors, multivariable linear regression(MLR) model was used to analyze the correlation between UA and hs-CRP and IL-6. The risk factors were analyzed using multi-factor logistic regression model and the predictive model was constructed. The goodness of fit(Hosmer-Lemeshow) test was used to predict the model. The predictive performance of the model was evaluated using the receiver operating characteristic(ROC) curve. The interactions were analyzed using an unconditional logistic regression model and a computational table developed by Andersson et al. The restricted cubic splines(RCS) model was used to evaluate the relationship between UA and AKI occurrence OR values.Results hs-CRP, IL-6, and UA were all positively correlated(P < 0.05), and after adjusting for confounding factors(Model 2), there was still a significant correlation(P < 0.05). Compared with the non-AKI group, the proportion of patients in the AKI group who received vasoactive drugs, mechanical ventilation, renal replacement therapy, septic shock, in-hospital mortality, and ICU hospitalization time were higher(P < 0.05), and the total hospitalization time was shorter(P < 0.05). In multivariate logistic regression analysis, if UA, hs-CRP, and IL-6 were included, UA, APACHE Ⅱ score, PCT, BUN, potassium ions, hs-CRP and IL-6 were all independent influencing factors for the occurrence of AKI(P < 0.05). ROC curve analysis resu

关 键 词：脓毒症 血尿酸 微炎症反应 急性肾损伤 

分 类 号：R459.7[医药卫生—急诊医学]