CDKN1A、HIF1A基因联合无创血流动力学监测对失血性休克致AKI的预测价值  

Predictive value of CDKN1A,HIF1A gene combined with noninvasive hemodynamic monitoring for AKI caused by hemorrhagic shock

作　　者：王芳 许晓军 周保正 张赵飞 吴方晨 Wang Fang;Xu Xiaojun;Zhou Baozheng;Zhang Zhaofei;Wu Fangchen(Department of Emergency,Xi′an Fengcheng Hospital,Xi′an 710016,China)

机构地区：[1]西安凤城医院急诊科,西安710016

出　　处：《中国临床实用医学》2025年第1期19-24,共6页China Clinical Practical Medicine

基　　金：西安市科技计划项目(2021YB26)。

摘　　要：目的探讨细胞周期蛋白依赖性激酶抑制剂1A(CDKN1A)、缺氧诱导因子1亚基α(HIF1A)基因联合无创血流动力学监测对失血性休克致急性肾损伤(AKI)的预测价值。方法本研究为回顾性病例对照研究,选取2022年3月至2024年6月西安凤城医院急诊科收治的156例失血性休克患者,男72例,女84例,年龄(62.56±6.58)岁,年龄范围为55~72岁。根据是否发生AKI分为非AKI患者(n=109)与AKI患者(n=47)。比较非AKI患者与AKI患者临床资料,外周血单个核细胞的CDKN1A mRNA、HIF1A mRNA水平,以及无创血流动力学监测指标。采用多因素logistic回归分析失血性休克患者发生AKI的影响因素。绘制受试者操作特征(ROC)曲线,分析CDKN1A mRNA、HIF1A mRNA及无创血流动力指标对失血性休克患者发生AKI的预测价值。结果AKI患者丙氨酸转氨酶[ALT,(36.59±7.61)U/L]、CDKN1A mRNA(1.80±0.37)、HIF1A mRNA(1.57±0.24)高于非AKI患者[(31.28±7.62)U/L、1.14±0.28、1.18±0.20];AKI患者血红蛋白[(56.24±6.27)g/L]、每搏输出量[SV,(60.67±5.04)ml]、每搏指数[(37.18±3.08)ml/m^(2)]低于非AKI患者[(60.48±6.18)g/L、(74.13±5.84)ml、(42.48±3.15)ml/m^(2)],差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,CDKN1A mRNA≥1.50(OR=3.077,95%CI:1.678~3.894)、HIF1A mRNA≥1.39(OR=3.473,95%CI:1.487~3.979)、血红蛋白≤57.89 g/L(OR=1.962,95%CI:1.150~2.364)、ALT≥34.09 U/L(OR=2.046,95%CI:1.161~2.873)是失血性休克患者发生AKI的独立危险因素,SV>69.05 ml(OR=0.456,95%CI:0.110~0.947)、每搏指数>40.14 ml/m^(2)(OR=0.512,95%CI:0.356~0.879)是失血性休克患者发生AKI的独立保护因素(P<0.05)。ROC曲线分析显示,CDKN1A mRNA、HIF1A mRNA、SV、每搏指数及联合检测预测失血性休克患者发生AKI的曲线下面积为0.784(95%CI:0.707~0.862)、0.735(95%CI:0.655~0.810)、0.638(95%CI:0.548~0.728)、0.641(95%CI:0.543~0.734)、0.831(95%CI:0.750~0.882),联合检测曲线下面积高于各指标单独检测。结论CDKN1A mRNA≥1ObjectiveTo investigate the predictive value of cyclin-dependent kinase inhibitor 1A(CDKN1A),hypoxia-inducible factor 1 subunitα(HIF1A)gene combined with noninvasive hemodynamic monitoring for acute kidney injury(AKI)caused by hemorrhagic shock.MethodsThis study was a retrospective case-control study,a total of 156 patients with hemorrhagic shock admitted to the department of Emergency in Xi′an Fengcheng Hospital from March 2022 to June 2024 were selected,including 72 males and 84 females,aged(62.56±6.58)years old,the age ranging from 55 to 72 years old.According to whether AKI occurred,they were divided into non-AKI patients(n=109)and AKI patients(n=47).The clinical data,the levels of CDKN1A mRNA and HIF1A mRNA in peripheral blood mononuclear cells and noninvasive hemodynamic monitoring indexes were compared.Multivariate logistic regression was used to analyze the influencing factors of AKI in patients with hemorrhagic shock.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CDKN1A mRNA,HIF1A mRNA and hemodynamic indexes for AKI in patients with hemorrhagic shock.ResultsThe alanine transaminase[ALT,(36.59±7.61)U/L],CDKN1A mRNA(1.80±0.37),HIF1A mRNA(1.57±0.24)of the AKI patients were higher than those of the non-AKI patients[(31.28±7.62)U/L,1.14±0.28,1.18±0.20],while the hemoglobin[(56.24±6.27)g/L],stroke volume[SV,(60.67±5.04)ml],stroke index[(37.18±3.08)ml/m^(2)]of the AKI patients were lower than those of the non-AKI patients[(60.48±6.18)g/L,(74.13±5.84)ml,(42.48±3.15)ml/m^(2)],and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that CDKN1A mRNA≥1.50(OR=3.077,95%CI:1.678 to 3.894),HIF1A mRNA≥1.39(OR=3.473,95%CI:1.487 to 3.979),hemoglobin≤57.89 g/L(OR=1.962,95%CI:1.150 to 2.364),ALT≥34.09 U/L(OR=2.046,95%CI:1.161 to 2.873)were independent risk factors for AKI in patients with hemorrhagic shock,SV>69.05 ml(OR=0.456,95%CI:0.110 to 0.947),stroke index>40.14 ml/m^(2)(OR=0.512,95%CI:0.356 to 0.879)wer

关 键 词：失血性休克 急性肾损伤 细胞周期蛋白依赖性激酶抑制剂1A 缺氧诱导因子1亚基α 血流动力学监测 

分 类 号：R459.7[医药卫生—急诊医学]