摘要
目的 探讨脓毒症相关急性肾损伤(AKI)患者血清肝素结合蛋白(HBP)、可溶性细胞间黏附分子1(sI-CAM-1)表达水平与病情严重程度及28 d预后的关系.方法 脓毒症AKI患者86例按患者病情将其分为轻度组(n=55)与重度组(n=31),根据患者28 d预后情况,将患者分为死亡组(n=22)与存活组(n=64).比较各组血清HBP、sICAM-1水平;收集患者一般资料[性别、年龄、体重指数、吸烟史、饮酒史、基础疾病、肺部感染部位、序贯器官衰竭评估评分(SOFA)以及急性生理学和慢性健康状况评价Ⅱ(APACHE Ⅱ)].使用Logistic回归模型分析影响患者预后的因素,使用受试者操作特征(ROC)曲线评价相关指标的预后预测价值.结果 较轻度组,重度组血清HBP、sICAM-1水平更高[(64.89±16.17)μg/L vs.(43.78±13.94)μg/L、(1 045.47±284.69)ng/mL vs.(826.88±231.68)ng/mL],差异均有统计学意义(P＜0.05).较存活组,死亡组SOFA评分、APACHEⅡ评分、降钙素原、HBP和sICAM-1水平均更高[(8.41±2.31)分 vs.(6.29±1.58)分、(26.59±3.71)分 vs.(22.74±3.94)分、(12.89±3.64)ng/mL vs.(10.21±3.12)ng/mL、(59.37±12.11)μg/L vs.(48.65±14.29)μg/L、(1 042.65±202.37)ng/mL vs.(858.59±259.41)ng/mL],差异均有统计学意义(P＜0.05);两组性别、年龄等一般资料及其他实验室指标比较,差异均无统计学意义(P＞0.05).Logistic回归分析得出,较高SOFA评分、较高HBP水平及较高sICAM-1水平均为脓毒症AKI患者28 d死亡的危险因素(P＜0.05).ROC曲线分析得出,血清HBP、sICAM-1均对脓毒症AKI患者28 d死亡有一定预测能力,其曲线下面积(AUC)分别为0.760、0.751,且与SOFA评分的预测能力(AUC为0.760)相比,差异无统计学意义(P＞0.05).结论 血清HBP、sICAM-1表达水平均与脓毒症AKI患者病情程度相关,可作为预后预测的生物标志物.
Abstract
Objective To investigate the relationship between serum levels of heparin-binding protein(HBP)and soluble intercellular adhesion molecule-1(sICAM-1)in patients with sepsis-associated acute kidney injury(AKI)and the severity of the disease and 28-day prognosis.Methods A total of 86 patients with sepsis AKI were divided into the mild group(n=55)and the severe group(n=31)according to the patient's condition.According to the 28-day prognosis of the patients,the patients were divided into the death group(n=22)and the survival group(n=64).The levels of serum HBP and sICAM-1 in each group were compared.General information of patients[gender,age,body mass index,smoking history,drinking history,underlying diseases,pulmonary infection site,sequential organ failure assessment(SOFA)score and acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ)score]were collected.The factors affecting the prognosis of pa-tients were analyzed using Logistic regression model analysis.The prognostic value of related indicators receiver was evaluated using receiver oper-ating characteristic(ROC)curve.Results Compared with the mild AKI group,the serum levels of HBP and sICAM-1 in the severe AKI group were higher[(64.89±16.17)μg/Lvs.(43.78±13.94)μg/L,(1 045.47±284.69)ng/mL vs.(826.88±231.68)ng/mL],the differ-ences were statistically significant(P＜0.05).Compared with the survival group,the SOFA score,APACHE Ⅱ score,procalcitonin,HBP and sICAM-1 levels in the death group were higher[(8.41±2.31)points vs.(6.29±1.58)points,(26.59±3.71)points vs.(22.74±3.94)points,(12.89±3.64)ng/mLvs.(10.21±3.12)ng/mL,(59.37±12.11)μg/Lvs.(48.65±14.29)μg/L,(1 042.65±202.37)ng/mL vs.(858.59±259.41)ng/mL],the differences were statistically significant(P＜0.05).Logistic regression analysis showed that higher SOFA score,higher HBP leveland higher sICAM-1 level were risk factors for 28-day death in patients with sepsis AKI(P＜0.05).ROC curve analysis showed that serum HBP and sICAM-1 had certain predictive ability for 28-day death in patients with sepsis AKI,and their area under the curve(AUC)was 0.760 and 0.751,respectively,and there was no statistically significant difference compared with the predictive abili-ty of SOFA score(AUC was 0.760)(P＞0.05).Conclusion The expression levels of serum HBP and sICAM-1 are related to the severity of sepsis AKI patients,and can be used as biomarkers for prognosis prediction.
基金项目
山西省基础研究计划青年科学研究项目(202203021222352)
NETL
NSTL
万方数据