血清CAF、penKid在脓毒症急性肾损伤中的表达及临床意义  

The expression and clinical significance of serum CAF and penKid in sepsis-induced acute kidney injury

作　　者：李萍[1] 王硕[1] 王玲[1] 王巍[1] 王秀娟[1] Li Ping;Wang Shuo;Wang Ling;Wang Wei;Wang Xiujuan(Department of Intensive Care Medicine,Fourth Affiliated Hospital of Nanjing Medical University,Jiangsu,Nanjing 210000,China)

机构地区：[1]南京医科大学第四附属医院重症医学科,210000

出　　处：《疑难病杂志》2025年第4期397-402,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：江苏省卫生健康委科研课题(ZD2020049)。

摘　　要：目的探讨血清集聚蛋白多糖C端片段(CAF)、脑啡肽原A 119-159(penKid)在脓毒症并发急性肾损伤(AKI)患者中的表达水平及临床意义。方法选取2021年3月—2024年3月南京医科大学第四附属医院重症医学科收治脓毒症合并AKI患者109例为合并AKI组,根据AKI分期标准分为Ⅰ期(n=46)、Ⅱ期(n=35)、Ⅲ期(n=28),患者均行肾脏代替疗法(CRRT)治疗,并根据治疗后28 d估计肾小球滤过率(eGFR)分为预后良好亚组(n=83)和预后不良亚组(n=26);于同期随机选取单纯脓毒症患者109例为脓毒症组。采用酶联免疫吸附法检测血清CAF、penKid水平,全自动生化分析仪检测血肌酐(SCr)、胱抑素C(Cys-C),计算eGFR;Pearson积矩相关或Spearman秩相关分析血清CAF、penKid与肾功能指标、AKI分期的关系;Logistic回归分析脓毒症并发AKI患者预后不良影响因素;受试者工作特征(ROC)曲线评估血清CAF、penKid对预后不良的预测价值。结果与脓毒症组比较,合并AKI组血清CAF、penKid、SCr、Cys-C水平升高,eGFR水平降低(t/P=15.363/<0.001、12.104/<0.001、18.038/<0.001、19.221/<0.001、20.776/<0.001);Ⅰ期、Ⅱ期、Ⅲ期患者血清CAF、penKid、SCr、Cys-C水平依次升高,eGFR水平依次降低(F/P=95.573/<0.001、49.832/<0.001、85.548/<0.001、79.249/<0.001、421.846/<0.001);血清CAF、penKid与AKI分期、SCr、Cys-C呈正相关,与eGFR呈负相关(CAF:r s/P=0.762/<0.001、0.703/<0.001、0.715/<0.001、-0.771/<0.001;penKid:r s/P=0.734/<0.001、0.668/<0.001、0.694/<0.001、-0.702/<0.001);与预后良好亚组比较,预后不良亚组AKI分期Ⅱ、Ⅲ期比例及血清CAF、penKid水平升高,eGFR水平降低(χ^(2)/t/P=10.085/0.007、18.446/<0.001、11.075/<0.001、15.252/<0.001);AKI分期Ⅱ期和Ⅲ期、CAF升高、penKid升高是脓毒症合并AKI患者预后不良独立危险因素[OR(95%CI)=1.130(1.032~1.236)、1.783(1.246~2.558)、1.586(1.157~2.173)、1.533(1.127~2.085)],eGFR升高是预后不良保护因素[OR(95%CI)=0.671(0.483~0.933)];�Objective To investigate the expression levels and clinical significance of serum C-terminal agrin fragment(CAF)and proenkephalin a 119-159(penKid)in patients with sepsis complicated with acute kidney injury(AKI).Met-hods A total of 109 patients with sepsis complicated with AKI admitted to the Department of Intensive Care Medicine,the Fourth Affiliated Hospital of Nanjing Medical University from March 2021 to March 2024 were selected as the AKI group.According to the AKI staging criteria,they were divided into stage I(n=46),stage II(n=35)and stage III(n=28).All patients were treated with renal replacement therapy(CRRT).According to the estimated glomerular filtration rate(eGFR)at 28 days after treatment,they were divided into good prognosis subgroup(n=83)and poor prognosis subgroup(n=26);109 patients with simple sepsis were randomly selected as sepsis group.Serum CAF and penKid levels were detected by enzyme-linked immunosorbent assay,serum creatinine(SCr),cystatin C(Cys-C)and estimated glomerular filtration rate(eGFR)were detected by automatic biochemical analyzer;Pearson product moment correlation or Spearman rank correlation was used to analyze the relationship between serum CAF,penKid and renal function index,AKI stage;logistic regression analysis was used to analyze the adverse prognostic factors in patients with sepsis complicated with AKI;the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum CAF and penKid for poor prognosis.Results Compared with the sepsis group,the levels of serum CAF and penKid,SCr and Cys-C in the AKI group were increased,and the level of eGFR was decreased(t/P=15.363/<0.001,12.104/<0.001,18.038/<0.001,19.221/<0.001,20.776/<0.001).The levels of serum CAF and penKid in patients with stageⅠ,stageⅡand stageⅢincreased in turn,the levels of SCr and Cys-C increased in turn,and the levels of eGFR decreased in turn,the differences were statistically significant(F/P=95.573/<0.001,49.832/<0.001,85.548/<0.001,79.249/<0.001,421.846/<0.001).Serum C

关 键 词：脓毒症 急性肾损伤 集聚蛋白多糖C端片段 脑啡肽原A119-159 预后 

分 类 号：R631[医药卫生—外科学] R692[医药卫生—临床医学]