舌下微循环、APACHIⅡ评分、NGAL和PCT预测脓毒症相关性急性肾损伤的临床价值  

Clinical value of sublingual microcirculation index,APACHEⅡ,NGAL and PCT for predicting sepsis-associated acute kidney injury

作　　者：黄媛 崔艳[1] 敖锦曦 罗富萍 李孟秦[1] HUANG Yuan;CUI Yan;AO Jinxi;LUO Fuping;LI Mengqin(Department of Emergency,the Affiliated Hospital of North Sichuan Medical College,Nan chong,Sichuan,637000,China)

机构地区：[1]川北医学院附属医院急诊医学科,四川南充637000

出　　处：《临床急诊杂志》2025年第1期66-72,78,共8页Journal of Clinical Emergency

摘　　要：目的:探讨舌下微循环[微血管流动指数(microvascular flow index,MFI)]、急性生理学与慢性健康状况评分Ⅱ(acute physiological and chronic health evaluationⅡ,APACHEⅡ)、中性粒细胞明胶酶相关脂钙蛋白(neutrophil gelatinase-associated lipocalin,NGAL)和降钙素原(procalcitonin,PCT)对预测脓毒症相关性急性肾损伤(sepsis-associated acute kidney injury,SA-AKI)的临床价值。方法:本研究采用单中心前瞻性纵向观察研究,纳入2023年10月-2024年6月在川北医学院附属医院重症监护病房住院的60例脓毒症患者。根据是否发展为继发性急性肾损伤(acute kidney injury,AKI)分为非AKI组(31例)和AKI组(29例)。收集患者一般资料(年龄、性别、体重指数、基础疾病)、在ICU入院的前24 h实验室检查结果、APACHEⅡ评分、舌下微循环参数。采用logistic分析SA-AKI的危险因素,进一步利用受试者工作特征曲线(ROC)进行深入分析各指标对SA-AKI的发生预测价值。结果:(1)AKI组APACHEⅡ评分、白介素-6、D-二聚体、NGAL显著高于非AKI组(P<0.05)。在AKI组中,MFI的数值显著低于非AKI组,差异有统计学意义(P<0.05)。(2)NGAL(OR=0.003,95%CI:1.003~1.103)和APACHEⅡ(OR=0.012,95%CI:1.055~1.545)是识别SA-AKI的独立危险因素。(3)ROC曲线分析显示,PCT、NGAL、APACHEⅡ评分、MFI与SA-AKI发生具有相关性,曲线下面积(AUC)分别为0.574(95%CI:0.427~0.722)、0.836(95%CI:0.722~0.951)、0.798(95%CI:0.675~0.921)、0.702(95%CI:0.562~0.841)。上述指标分别与MFI联合检测AUC分别为0.700(95%CI:0.561~0.84)、0.876(95%CI:0.78~0.971)、0.817(95%CI:0.708~0.927)。结论:NGAL、APACHEⅡ评分、MFI与SA-AKI发生具有相关性,联合检测NGAL和MFI与SA-AKI相关性最好,对SA-AKI发生有一定预测价值。Objective:To investigate the clinical value of the sublingual microcirculation index(microvascular flow index,MFI),acute physiological and chronic health evaluationⅡ(APACHEⅡ)score,neutrophil gelatinase-associated lipocalin(NGAL),and procalcitonin(PCT)in the early identification of sepsis-associated acute kidney injury(SA-AKI).Methods:A single-center,prospective,longitudinal observational study was conducted,involving sepsis patients admitted to the Critical Care Units of the Hospital Affiliated with North Sichuan Medical College between October 2023 and June 2024.Patients were categorized into two groups:non-AKI group(n=31)and AKI group(n=29),based on the development of secondary AKI.Demographic data(including age,sex,body mass index and fundamental diseases),laboratory tests,and the APACHEⅡscore were collected within the first 24 hours of admission.Logistic regression analysis was conducted to identify the risk factors for SA-AKI,and the predictive value of indicators was further evaluated using receiver operating characteristic(ROC)curves.Results:(1)Interleukin-6,D-dimer,NGAL,and APACHEⅡscore were higher in the AKI group compared to the non-AKI group(P<0.05).The MFI in the AKI group was significantly lower than that in the non-AKI group(P<0.05).(2)NGAL(OR=0.003,95%CI:1.003-1.103)and APACHEⅡ(OR=0.012,95%CI:1.055-1.545)were identified as independent risk predictors for SA-AKI.(3)ROC curve analysis suggested that PCT,NGAL,APACHEⅡscore and MFI had predictive value for sepsis-associated acute kidney injury,with AUCs of 0.574(95%CI:0.427-0.722),0.836(95%CI:0.722-0.951),0.798(95%CI:0.675-0.921),and 0.702(95%CI:0.562-0.841),respectively.Additionally,combined detection of the above indicators(PCT,NGAL and APACHEⅡscore)and MFI yielded AUCs were 0.700(95%CI:0.561-0.840),0.876(95%CI:0.780-0.971),and 0.817(95%CI:0.708-0.927).Conclusion:NGAL,APACHEⅡscore and MFI exhibit a significant correlation in the context of SA-AKI,and the combined detection of NGAL and MFI holds predictive value for the development of S

关 键 词：脓毒症 舌下微循环 急性肾损伤 中性粒细胞明胶酶相关脂钙蛋白 

分 类 号：R459.7[医药卫生—急诊医学]