β_(2)-MG联合N/LPR对重症急性胰腺炎患者急性肾损伤的预测价值  

Value ofβ_(2)-MG combined with N/LPR in predicting acute kidney injury in patients with severe acute pancreatitis

作　　者：白龙 贺小龙 姬妍娜 邢小艳 Bai Long;He Xiao-long;Ji Yan-na;Xing Xiao-yan(Department of Critical Care Medicine,Yan'an Hospital of Traditional Chinese Medicine,Yan'an,Shanxi 716099,China)

机构地区：[1]延安市中医医院重症医学科,陕西延安716099

出　　处：《中国现代医学杂志》2025年第6期78-83,共6页China Journal of Modern Medicine

基　　金：陕西省重点研发计划项目(No:2024SF-YBXM-102)。

摘　　要：目的探讨β_(2)微球蛋白(β_(2)-MG)、中性粒细胞/淋巴细胞和血小板比值(N/LPR)检测对重症急性胰腺炎(SAP)患者急性肾损伤(AKI)的预测价值。方法前瞻性选取2021年1月—2024年3月延安市中医医院收治的159例SAP患者。根据患者住院期间AKI发生情况分为AKI组、非AKI组。收集患者治疗前β_(2)-MG、N/LPR等资料,分析AKI组、非AKI组β_(2)-MG、N/LPR水平及影响SAP患者并发AKI的因素,分析β_(2)-MG、N/LPR的交互作用对SAP患者并发AKI的影响,分析β_(2)-MG、N/LPR预测SAP患者并发AKI的价值。结果两组患者性别构成、年龄、体质量指数、SAP类型构成、基础疾病、冠心病、吸烟史、饮酒史、并发腹腔间隔室综合征、并发全身炎症反应综合征、休克、甘油三酯、总胆固醇、白细胞计数、淀粉酶、血红蛋白、纤维蛋白原比较,差异均无统计学意义(P>0.05)。AKI组PACHEⅡ评分、血乳酸、血肌酐、尿素氮、胱抑素C、C反应蛋白、β_(2)-MG、N/LPR均高于非AKI组(P<0.05)。多因素逐步Logistic回归分析,结果显示:β_(2)-MG水平高[OR=4.314(95%CI:1.673,11.125)]、N/LPR水平高[OR=3.991(95%CI:1.193,13.353)]、血肌酐水平高[OR=4.444(95%CI:1.410,14.005)]、胱抑素C水平高[OR=8.919(95%CI:1.904,41.788)]、β_(2)-MG/N/LPR交互作用[OR=5.692(95%CI:1.945,16.652)]均是影响SAP患者并发AKI的危险因素(P<0.05)。受试者工作特征曲线分析结果显示,β_(2)-MG、N/LPR及两者联合预测SAP患者并发AKI的敏感性分别为68.85%(95%CI:0.603,0.741)、70.73%(95%CI:0.637,0.819)、82.93%(95%CI:0.714,0.905),特异性分别为71.19%(95%CI:0.669,0.854)、68.64%(95%CI:0.637,0.812)、89.83%(95%CI:0.809,0.934),曲线下面积分别为0.713(95%CI:0.610,0.816)、0.734(95%CI:0.623,0.846)、0.883(95%CI:0.815,0.952)。结论β_(2)-MG、N/LPR与SAP患者并发AKI有关,两者在SAP患者并发AKI中具有正向交互作用,其联合预测SAP患者并发AKI效能良好。Objective To investigate the value ofβ_(2)-microglobulin(β_(2)-MG)and the neutrophils to lymphocytes and platelets ratio(N/LPR)in predicting acute kidney injury(AKI)in patients with severe acute pancreatitis(SAP).Methods The 159 SAP patients admitted to our hospital from January 2021 to March 2024 were prospectively selected.Patients were divided into the AKI and non-AKI groups according to the occurrence of AKI during hospitalization.The clinical data includingβ_(2)-MG and N/LPR before treatment were collected.The levels ofβ_(2)-MG and N/LPR in the AKI group and the non-AKI group and the factors affecting the concurrent AKI in SAP patients were analyzed.The interaction betweenβ_(2)-MG and N/LPR on the concurrent AKI in SAP patients and the value ofβ_(2)-MG and N/LPR in predicting AKI in SAP patients were determined.Results There were no statistically significant differences between the two groups in terms of sex composition,age,body mass index,SAP type distribution,underlying diseases,coronary heart disease,smoking history,alcohol consumption history,complications of abdominal compartment syndrome,systemic inflammatory response syndrome,shock,triglycerides,total cholesterol,white blood cell count,amylase,hemoglobin,and fibrinogen(P>0.05).The APACHE II score and levels of blood lactate,blood creatinine,urea nitrogen,cystatin C,C-reactive protein,β_(2)-MG,and N/LPR in the AKI group were higher than those in the non-AKI group(P<0.05).The results of multivariable stepwise Logistic regression analysis(P=0.05 for including variables and P=0.10 for excluding variables)showed that the levels ofβ_(2)-MG[OR=4.314(95%CI:1.673,11.125)],N/LPR[OR=3.991(95%CI:1.193,13.353)],blood creatinine[OR=4.444(95%CI:1.41014.005)]and cystatin C[OR=8.919(95%CI:1.904,41.788)],as well as the interaction betweenβ_(2)-MG and N/LPR[OR=5.692(95%CI:1.945,16.652)]were factors affecting concomitant AKI in patients with SAP(P<0.05).The ROC curve analysis exhibited that the sensitivities ofβ_(2)-MG,N/LPR and their combination in predicting

关 键 词：重症急性胰腺炎 β_(2)微球蛋白 中性粒细胞/淋巴细胞和血小板比值 急性肾损伤 价值 

分 类 号：R657.51[医药卫生—外科学]