摘要
目的研究血清胱抑素C(CysC)、尿微量白蛋白(UmAlb)、血肌酐(Scr)在脓毒症合并急性肾损伤(AKI)患者中的表达及疾病预测价值。方法选择2019年10月至2020年10月间宜昌市夷陵医院收治的117例脓毒症患者纳为研究对象,根据患者是否并发AKI,将其分为AKI组(51例)与非AKI(NAKI)组(66例),AKI组以AKI诊断成立当日记为T-0 d,诊断成立前2 d分别记为T-1 d及T-2 d,NAKI组以进入重症监护室(ICU)前3 d分别记为T-0d、T-1 d及T-2 d,记录两组各时间点的血清CysC、UmAlb及Scr水平及组内各指标变化,并绘制受试者工作特征(ROC)曲线,分析血清CysC、UmAlb、Scr在预测脓毒症合并AKI中的价值。结果AKI组的APACHEⅡ评分显著高于NAKI组(P<0.05),28 d死亡病例数显著多于NAKI组(P<0.05);AKI组患者的血清CysC水平在T-0 d、T-1 d及T-2 d时均显著高于NAKI组的同时间段水平(均P<0.05),AKI组的血清CysC水平随时间变化逐渐升高(P<0.05);AKI组患者的血清Scr水平在T-1 d及T-2 d时与NAKI组同时间段比较,差异无统计学意义(P>0.05)。在T-0 d时,AKI组患者的血清Scr水平显著高于NAKI组(P<0.05);AKI组患者T-0 d时的Scr水平显著高于T-1 d及T-2 d(P<0.05);T-2 d时,两组患者的UmAlb水平比较,差异无统计学意义(P>0.05);在T-1 d及T-0 d时,AKI组患者的UmAlb水平均显著高于NAKI组(P<0.05);AKI组患者的UmAlb水平随时间变化显著升高(P<0.05);在T-2 d及T-1 d时,AKI组患者的肾小球滤过率(GFR)水平与NAKI组同时间段比较,差异无统计学意义(P>0.05),而在T-0 d时AKI组患者的GFR水平显著低于NAKI组(P<0.05);相关性分析提示,T-1 d时,AKI组患者的血清CysC、Scr及UmAlb水平与GFR均呈正相关(均P<0.05);绘制ROC曲线结果提示,T-1 d时血清CysC[曲线下面积(AUC)=0.865,95%CI:0.797~0.934,灵敏度为84.3%,特异度为83.3%]在预测AKI中的效能高于Scr(AUC=0.633,95%CI:0.528~0.739,灵敏度为56.9%,特异度为71.2%)及UmAlb(AUC=0.756,95%CI:0.669~0.843,灵敏度为64.7%,特异度为75.8%
Objective To investigate the expression levels and predictive value of serum cystatin C(CysC),urinary microalbumin(UmAlb)and serum creatinine(Scr)in patients with sepsis and acute kidney injury(AKI).Methods A total of 117 patients with sepsis in yiling hospital from October 2019 to October 2020 were included,and divided into two groups according to the presence or absence of AKI,AKI group(n=51)and NAKI group(n=66).In AKI group,the diagnosis day was set as T-0d,and the two days before diagnosis were set as T-1d and T-2d,while the recording day of NAKI group was set at three days before entering intensive care unit(ICU),T-0 d,T-1 d and T-2 d.The changes of serum CysC,UmAlb and Scr levels at each time point of two groups were recorded,and the receiver operating characteristic(ROC)curve was used to analyze the value of CysC,UmAlb,and Scr in predicting AKI in sepsis patients.Results The acute physiology and chronic health evaluation(APACHE II)score of AKI group was significantly higher than that of NAKI group(P<0.05),and the 28 days mortality rate was significantly higher that of NAKI group(P<0.05);Serum CysC levels at T-2 d,T-1 d and T-0 d in AKI group were significantly higher than that of NAKI group at the corresponding time point(P<0.05).Serum CysC levels in AKI group were gradually increased over time(P<0.05);Scr levels at T-2 d and T-1 d in AKI group yielded no significant difference with those of NAKI group(P>0.05),while Scr levels at T-0 d of AKI group were significantly higher than those of NAKI group(P<0.05).Within AKI group,Scr level at T-0 d were significantly higher than that at T-2 d and T-1 d(P<0.05).UmAlb levels at T-2 d demonstrated no significant difference between groups(P>0.05),while UmAlb levels at T-1 d and T-0 d of AKI group were significantly higher than those of NAKI group(P<0.05).UmAlb level of AKI group showed a significant increasing trend over time(P<0.05).The glomerular filtration rate(GFR)values at T-2 d and T-1 d showed no significant difference between groups(P>0.05),while GFR values a
作者
易雪琳
欧阳亮
庹玲
Yi Xuelin;Ouyang Liang;Tuo Ling(Department of General Medicine,Yiling Hospital,Yichang 443100,China;Department of Internal Medicine,Yiling Women's and Children's Hospital,Yichang 443100,China)
出处
《国际泌尿系统杂志》
2022年第1期72-76,共5页
International Journal of Urology and Nephrology
