血清AIFM2、UMOD水平对重症急性胰腺炎并发急性肾损伤的预测价值  

The predictive value of serum AIFM2 and UMOD levels for acute kidney injury in patients with severe acute pancreatitis

作　　者：刘毓杰 沈晨 马鹏飞[1] 郑幼伟 Liu Yujie;Shen Chen;Ma Pengfei;Zheng Youwei(Department of Hepatobiliary,First Affiliated Hospital of Henan University of Science and Technology,Henan Province,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院肝胆外科,河南洛阳471000

出　　处：《疑难病杂志》2024年第11期1346-1351,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220031)。

摘　　要：目的研究重症急性胰腺炎(SAP)患者血清线粒体相关凋亡因子2(AIFM2)、尿调节素(UMOD)水平对SAP患者并发急性肾损伤(AKI)的预测价值。方法选取2020年3月—2023年3月河南科技大学第一附属医院肝胆外科收治的SAP患者182例为SAP组,根据是否并发AKI将SAP患者分为AKI亚组(n=50)和非AKI亚组(n=132)。另选取同期医院健康体检者60例为健康对照组。采用酶联免疫吸附法(ELISA)测定血清AIFM2、UMOD水平;Pearson相关性分析血清AIFM2、UMOD水平与肾功能指标的相关性;多因素Logistic回归分析SAP患者并发AKI的影响因素;受试者工作特征(ROC)曲线评估血清AIFM2、UMOD水平对SAP患者并发AKI的预测价值。结果SAP组血清AIFM2水平高于健康对照组,血清UMOD水平低于健康对照组(t/P=25.618/<0.001、48.340/<0.001);182例SAP患者AKI发生率为27.47%(50/182)。AKI亚组血肌酐(SCr)、血尿素氮(BUN)、Ranson评分、血清AIFM2高于非AKI亚组,血清UMOD低于非AKI亚组(t/P=45.463/<0.001,26.748/<0.001,27.264/<0.001,18.075/<0.001,14.273/<0.001);Pearson相关性分析显示,AKI亚组SAP患者SCr、BUN、Cys C与血清AIFM2水平呈正相关(r/P=0.725/<0.001,0.621/<0.001,0.637/<0.001),与血清UMOD水平呈负相关(r/P=-0.710/<0.001,-0.636/<0.001,-0.671/<0.001);多因素Logistic回归结果显示,SCr、BUN、Ranson评分、AIFM2升高是SAP患者并发AKI的独立危险因素[OR(95%CI)=1.589(1.258~2.006),1.594(1.252~2.028),1.451(1.120~1.879),1.419(1.085~1.856)],血清UMOD升高是独立保护因素[OR(95%CI)=0.628(0.493~0.799)];血清AIFM2、UMOD水平及二者联合预测SAP患者并发AKI的AUC分别为0.871、0.862、0.938,二者联合的AUC大于血清AIFM2、UMOD水平单独预测(Z=4.344、4.840,P均<0.001)。结论SAP并发AKI患者血清AIFM2升高、UMOD降低,均与病情程度有关,二者联合对SAP并发AKI的发生具有较高的评估价值。Objective To investigate the levels of serum mitochondrial associated apoptosis factor 2(AIFM2)and uromodulin(UMOD)in patients with severe acute pancreatitis(SAP),and their predictive value for acute kidney injury(AKI)in SAP.Methods One hundred and eighty-two SAP patients(SAP group)treated at the First Affiliated Hospital of Henan University of Science and Technology from March 2020 to March 2023 were selected.Based on whether they had concurrent AKI,the SAP group was divided into a non-AKI group(132 cases)and an AKI group(50 cases),with 60 healthy individuals as the control group during the same period.Enzyme linked immunosorbent assay was used to detect serum AIFM2 and UMOD levels.The evaluation value of serum AIFM2 and UMOD for SAP complicated with AKI was assessed using logistic regression model and receiver operating characteristic curve.Results The serum AIFM2 level in the SAP group was higher than that in the control group,and the serum UMOD level was lower than that in the control group(t=25.618,48.340,P<0.001).The serum AIFM2 level,blood urea nitrogen level,blood creatinine level,and Ranson score in the AKI group were higher than those in the non-AKI group,and the serum UMOD level was lower than that in the non-AKI group(t/P=45.463/<0.001,26.748/<0.001,27.264/<0.001).The serum creatinine,blood urea nitrogen,cystatin C,and Ranson score of AKI group SAP patients were positively correlated with serum AIFM2(r/P=0.725/<0.001,0.621/<0.001,0.637/<0.001)and negatively correlated with serum UMOD(r/P=-0.710/<0.001,-0.636/<0.001,-0.671/<0.001).Blood urea nitrogen,blood creatinine,Ranson score,and serum AIFM2 were risk factors for SAP complicated with AKI[OR(95%CI)=1.589(1.258-2.006),1.594(1.252-2.028),1.451(1.120-1.879),1.419(1.085-1.856)],while serum UMOD was a protective factor[OR(95%CI)=0.628(0.493-0.799)].The area under the curve(95%CI)of serum AIFM2 and UMOD combined for the evaluation of SAP complicated AKI was 0.938(0.889-0.959),which was higher than that of serum AIFM2.UMOD single detection was 0.871(0.831~

关 键 词：重症急性胰腺炎 急性肾损伤 线粒体相关凋亡因子2 尿调节素 预测价值 

分 类 号：R576[医药卫生—消化系统]