血清NGAL、CysC、尿素氮联合对脓毒症致急性肾损伤的预测价值  

The Predictive Value of the Combination of Serum NGAL,CysC,BUN for Sepsis⁃Associated Acute Kidney Injury

作　　者：李琳[1] 张先江[1] 周云[2] LI Lin;ZHANG Xianjiang;ZHOU Yun(Department of Intensive Care Medicine,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China;Department of Radiotherapy,Xuzhou Central Hospital,Xuzhou,Jiangsu 221009,China)

机构地区：[1]徐州市中心医院重症医学科,江苏徐州221009 [2]徐州市中心医院放疗科,江苏徐州221009

出　　处：《转化医学杂志》2024年第6期840-845,共6页Translational Medicine Journal

基　　金：江苏省妇幼保健科研项目(F202035)。

摘　　要：目的分析血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(CysC)、尿素氮(BUN)联合对脓毒症致急性肾损伤(SA-AKI)的预测价值。方法选取2020年2月至2023年2月徐州市中心医院收治的298例脓毒症患者为研究对象,其中男156例,女142例;根据是否发生AKI,将患者分为SA-AKI组(82例)和非SA-AKI组(216例),SA-AKI组根据AKI严重程度分为轻度SA-AKI组(I期,33例)、重度SA-AKI组(Ⅱ~Ⅲ期,49例)。收集298例脓毒症患者的一般资料,检测实验室及血清指标,多因素Logistic回归分析影响因素;NGAL、CysC、BUN对SAAKI的预测价值采用受试者工作特征(ROC)曲线评估。结果SA-AKI组连续器官衰竭评估(SOFA)评分高于非SAAKI组,差异有统计学意义(P<0.05);SA-AKI组C反应蛋白(CRP)、BUN、CysC、NGAL均高于非SA-AKI组(P<0.05),肾小球滤过率(eGFR)低于非SA-AKI组,差异有统计学意义(P<0.05);重度SA-AKI组CRP、BUN、CysC、NGAL均高于轻度SA-AKI组,差异有统计学意义(P<0.05);重度SA-AKI组eGFR低于轻度SA-AKI组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,SOFA评分、BUN、CysC、eGFR、NGAL均是SA-AKI的影响因素(P<0.05);ROC曲线显示,NGAL、CysC、BUN预测SA-AKI的曲线下面积(AUC)为0.867、0.794、0.788,三者联合对SA-AKI预测的AUC为0.945(Z_(联合VS NGAL)=4.604、P<0.001;Z_(联合VS CysC)=6.143、P<0.001;Z_(联合VS BUN)=6.308、P<0.001)。结论SA-AKI患者血清NGAL、CysC、BUN高表达,三者联合用于SA-AKI预测的价值较高。Objective To analyze the predictive value of the combination of serum neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys-C),and blood urea nitrogen(BUN)for sepsis-associated acute kidney injury(SA-AKI).Methods A study was conducted on 298 sepsis patients admitted to our hospital between February 2020 and February 2023.According to the occurrence of AKI,they were assigned into SA-AKI group(n=82)and non SA-AKI group(n=216),and further assigned into mild SA-AKI group(stage I,n=33)and severe SA-AKI group(stagesⅡ-Ⅲ,n=49)based on the severity of AKI.General information of 298 sepsis patients was collected.Laboratory and serum indicators were tested.Multivariate logistic regression was applied to analyze the influencing factors.The predictive value of NGAL,CysC,and BUN for SAAKI was evaluated using receiver operating characteristic(ROC)curves.Results The sequential organ failure assessment(SOFA)score in the SA-AKI group was higher than that in the non SA-AKI group(P<0.05).The levels of C-reactive protein(CRP),BUN,CysC,and NGAL in the SA-AKI group were higher than those in the non SA-AKI group(P<0.05),and the glomerular filtration rate(eGFR)was lower than that in the non SA-AKI group(P<0.05).The levels of CRP,BUN,CysC,and NGAL in the severe SA-AKI group were higher than those in the mild SA-AKI group(P<0.05),while eGFR was lower than that in the mild SA-AKI group(P<0.05).Multiple logistic regression analysis showed that SOFA score,BUN,CysC,eGFR,and NGAL were all influencing factors of SA-AKI(P<0.05).ROC curve showed that the area under the curve(AUC)of NGAL,CysC,and BUN in predicting SA-AKI was 0.867,0.794,and 0.788,respectively.The combination of the three factors had a higher AUC for predicting SA-AKI(0.945)(Z_(combination vs.NGAL)=4.604,P<0.001;Z_(combination vs.CysC)=6.143,P<0.001;Z_(combination vs.BUN)=6.308,P<0.001).Conclusion Serum NGAL,CysC,and BUN are highly expressed in SA-AKI patients.The combined use of the three for SA-AKI prediction has high value.

关 键 词：脓毒症 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 胱抑素C 尿素氮 预测 

分 类 号：R631[医药卫生—外科学]