部分活化凝血活酶时间、乳酸脱氢酶-1及中性粒细胞在劳力型中暑合并横纹肌溶解所致急性肾损伤的相关性分析  

Relationship between partial activated thromboplastin time,lactate dehydrogenase-1,neutrophils and rhabdomyolysis associated acute kidney injury in exertional heat stroke patients

作　　者：戴靖榕 李慧 刘斌[3] Dai Jingrong;LiHui;Liu Bin(Department of General Practice,The First Hospital of Changsha,Changsha 410005,China;Department of critical care,General Hospital of Southern Theatre Command,PLA,Guangzhou 510000,China;Department of Emergency,The First Hospital of Changsha,Changsha 410005,China)

机构地区：[1]长沙市第一医院(中南大学湘雅医学院附属长沙医院)全科医学科,长沙410005 [2]中国人民解放军南部战区总医院重症医学科,广州510000 [3]长沙市第一医院(中南大学湘雅医学院附属长沙医院)急诊科,长沙410005

出　　处：《中华急诊医学杂志》2025年第3期404-410,共7页Chinese Journal of Emergency Medicine

基　　金：长沙市自然科学基金(Kq2202010)。

摘　　要：目的 为分析劳力型中暑(exertional heat strokeEHS)合并横纹肌溶解(rhabdomyolysis,RM)患者中部分活化凝血活酶时间(activatedpartial thromboplastin,APTT)乳酸脱氢酶-1(lactate dehydrogenase-1,LDH-1)及中性粒细胞(neutrophil granulocyte,NEU)与急性肾损伤(acute kidney injury,AKI)的相关性。方法 回顾性收集2008年5月至2019年11月在南部战区总医院住院的EHS患者261例,其中合并RM患者147例,收集患者基本资料及外周血指标,并根据是否合并AKI,将RM患者分为非AKI组和AKI组;采用二元Logistic回归分析RM合并AKI的独立影响因素,应用ROC曲线分析相关指标对RM并发AKI的预测价值。结果 147例RM患者中,合并有AKI患者57例(38.8%)。将RM是否合并AKI为因变量,将所有单因素分析差异具有统计学意义(P<0.05)的变量作为自变量采用二分类Logistic分析得出模型1,采用前向筛选得出模型2。模型2结果显示:NEU(OR=1.196,95%CI:1.082~1.322,P<0.05)、LDH-1(OR=1.015,95%CI:1.005~1.024,P<0.05)及APTT(OR=1.013,95%CI:1.004~1.022,P<0.05)是RM合并AKI患者的独立危险因素(均P<0.05),其模型1的AIC为166.914,模型2AIC为150.276,提示模型2优于模型1。此外,NEU、LDH-1联合APTT对RM并发AKI的预测价值:ROC曲线下面积为0.830(95%CI:0764~0.897),其临界值≥0.387时提示RM并发AKI,特异性为0.719,敏感度为0.811。结论 NEU、LDH-1及APTT与RM合并AKI密切相关,并通过联合检测NEU、LDH-1及APTT有助于早期诊断RM并发AKI。Objective To investigate the relationship between partial activated thromboplastin time(APTT),lactate dehydrogenase-1(LDH-1),neutrophil(NEU)and rhabdomyolysis(RM)-associated acute kidney injury(AKI)in exertional heat stroke(EHS)patients.Methods The valid data of 261 EHS patients hospitalized in the General Hospital of the Southern Theater Command of the PLA from May 2008 to November 2019 were respectively included as the study objects,including 147 patients with RM.Basic data and peripheral blood indexes of the patients were collected,and the patients with RM were divided into non-AKI group and AKI group according to whether they had AKI.Binary Logistic regression was used to analyze the independent influencing factors of RM combined with AKI,and ROC curve was used to analyze the predictive value of relevant indicators on RM concurrent AKI.Results Among 147 patients with RM,57(38.8%)had AKI.Using whether RM was combined with AKI as the dependent variable,variables showing statistical significance(P<0.05)in univariate analysis were included as independent variables.Model 1 was established through binary logistic regression analysis,while Model 2 was derived using forward selection.The results of Model 2 revealed that NEU(OR=1.196,95%CI:1.082-1.322,P<0.05),LDH-1(OR=1.015,95%CI:1.005-1.024,P<0.05),and APTT(OR=1.013,95%CI:1.004-1.022,P<0.05)were independent risk factors for RM patients complicated with AKI(all P<0.05).The AIC value for Model 1 was 166.914,while that for Model 2 was 150.276,indicating that Model 2 outperformed Model 1.The predictive value of NEU,LDH-1 combined with APTT for RM complicated by AKI:The area under the ROC curve(AUC)was 0.830(95%CI:0.764-0.897).When the critical value is≥0.387,it indicates RM complicated by AKI,with a specificity of 0.719 and a sensitivity of 0.811.Conclusions NEU,LDH-1 and APTT are closely related to AKI in RM,and the combined detection of NEU,LDH-1 and APTT is helpful for early diagnosis of AKI in RM.

关 键 词：劳力型中暑 横纹肌溶解 急性肾损伤 部分活化凝血活酶时间 乳酸脱氢酶-1 中性粒细胞 

分 类 号：R69[医药卫生—泌尿科学]