摘要
目的:探讨硫氧还蛋白互作蛋白(TXNIP)、神经纤毛蛋白-1(NRP1)对脓毒症患者发生急性肾损伤(AKI)的预测价值。方法:选取2019年4月-2021年4月在本院住院的160例脓毒症患者为研究对象,以患者7 d内是否发生AKI将患者分为AKI组56例和非AKI组104例,再对AKI患者进行分组,分为AKIⅠ期、AKIⅡ期、AKIⅢ期。酶联免疫吸附法血清TXNIP、NRP1水平;多因素Logistic回归分析脓毒症患者发生AKI的可能影响因素;受试者工作特征(ROC)曲线评估血清TXNIP、NRP1水平检测对脓毒症患者发生AKI的预测价值。结果:AKI组SOFA评分、Scr水平、APACHEⅡ评分及PCT水平均显著高于非AKI组,eGFR水平显著低于非AKI组(P<0.05)。AKI组TXNIP水平显著高于非AKI组,且随AKI分期增加而显著增加(P<0.05);NRP1水平显著低于非AKI组,且随AKI分期增加而显著降低(P<0.05)。AKI患者血清TXNIP水平与SOFA评分、Scr、APACHEⅡ评分均呈正相关(r=0.342、0.361、0.335,P<0.05),与eGFR呈负相关(r=-0.495,P<0.05);血清NRP1水平与SOFA评分、Scr、APACHEⅡ评分均呈负相关(r=-0.310、-0.327、-0.306,P<0.05),与eGFR呈正相关(r=0.561,P<0.05)。Logistic回归分析显示,高水平TXNIP、Scr、SOFA评分是脓毒症患者并发AKI的危险因素(P<0.05),高水平NRP1是脓毒症患者并发AKI的保护因素(P<0.05)。ROC曲线显示,TXNIP、NRP1预测AKI的AUC为0.737、0.720,二者联合预测AKI的AUC为0.929,显著高于二者单独预测(Z_(联合VSTXNIP)=4.642、P=0.004;Z联合VS NRP1=4.929、P=0.025),其敏感度、特异度分别为90.79%、85.29%。结论:脓毒症并发AKI患者血清中TXNIP高表达,NRP1低表达,与AKI严重程度有关,且二者联合对脓毒症并发AKI具有一定的预测价值。
Objective:To analyze the predictive value of thioredoxin interacting protein(TXNIP)and neuronilin-1(NRP1)for acute renal injury(AKI)in sepsis patients.Methods:160 patients with sepsis admitted to our hospital from April 2019 to April 2021 were selected as the study object.According to the occurrence of AKI within 7 days,the patients were divided into AKI group(56 cases)and non-AKI group(104 cases),and then AKI patients were divided into stage I,stage II and stage II.Ser-um TXNIP and NRP1 levels by ELISA;multivariate logistic regression analysis was used to analyze the possible influencing factors of AKI in sepsis patients;the predictive value of serum TXNIP and NRP1 levels in the development of AKI in sepsis patients was evalua-ted by ROC curve.Results:The SOFA score,Scr level,APACHE II score and PCT level in AKI group were obviously higher than those in non AKI group,the eCFR level was obviously lower than that in non AKI group(P<0.05).The TXNIP level in AKI group was obviously higher than that in non AKI group,and increased obviously with the increase of AKI stage(P<0.05);NRP1 level was obviously lower than that of non AKI group,and decreased obviously with the increase of AKI stage(P<0.05).Serum TXNIP level in AKI patients was positively correlated with SOFA score,Scr and APACHEII score(r=0.342,0.361,0.335,P<0.05),and negatively correlated with eGFR(r=-0.495,P<0.05).Serum NRP1 level was negatively correlated with SOFA score,Scr,A-PACHE II score(r=-0.310,--0.327,-0.306,P<0.05),and positively correlated with eGFR(r=0.561,P<0.05).Logis-tic regression analysis showed that high TXNIP,Scr and SOFA score were risk factors for AKI in sepsis patients(P<0.05),the high NRP1 level was the protective factor of AKI in sepsis patients(P<0.05).The ROC curve showed that the AUC of TXNIP and NRP1 for predicting AKI was 0.737 and 0.720,and the AUC of the combination of TXNIP and NRP1 for predicting AKI was 0.929,which was obviously higher than that of the combination of TXNIP and NRP1 alone(Z combination VS.TXNIP=4.642,P=0.004;Z
作者
樊子勉
张俊
张文龙
陈春燕
FAN Ziman;ZHANG Jun;ZHANG Wenlong(Chengdu Sixth People's Hospital,Chengdu610051)
出处
《中国中西医结合肾病杂志》
2024年第5期403-407,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
成都市医学科研项目(No.2021353)。
