半胱氨酸蛋白酶抑制剂C和β2微球蛋白对脓毒症患者早期急性肾损伤诊断和预后的价值

Assessment of the significance of cysteine proteinase inhibitor C and β2 microglobulin in the diagnosis and prognosis of sepsis-induced acute kidney injury

目的探讨半胱氨酸蛋白酶抑制剂C（Cys—C）和β2微球蛋白（β2MG）对脓毒症急性肾损伤的早期诊断价值，Cys-C与急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）的相关性及预后的价值。方法选取自2008年10月至2009年10月在北京朝阳医院急诊抢救室收治的脓毒症患者250例，来院时分别测定血清肌酐（SCr）、B2MG、Cys—C，计算APACHEII评分，并观察28d死亡率，其中发生急性肾损伤者63例，未发生急性肾损伤187例。利用受试者工作特征曲线（ROC）下面积、Cys—C与β2MG预测急性肾损伤发生的准确性，并探讨在脓毒症急性肾损伤中Cys—C水平改变与APACHEII评分的关系。结果急性肾损伤组Cys-C、β2MG浓度均高于非急性肾损伤组[分别为（1189±214）μg/L vs．（678±118）肛∥L，P=0．007；（3705±599）μg/Lvs．（2365±446）μg/L，P=0．004]。急性肾损伤组SCr浓度、APACHEII评分高于非急性肾损伤组[分别为（145±49）分vs．（73±25）分，P=0．013；（19±4）分vs（13±4）分，P=0．016]。急性肾损伤组患者Cys-C与APACHEⅡ评分有良好相关性（P〈0．01）。急性肾损伤组28d死亡率高于非急性肾损伤组（P〈0．01）。Cys-C（OR=1．006，95％CI=1．002—1．009），ROC下面积是0．909；血p2MG（OR=1．001，95％CI=1．000—1．001），ROC下面积是0．820。结论监测血清Cys—C和血β2MG浓度可有效预测脓毒症患者发生急性肾损伤；与β2MG相比，Cys-C预测急性肾损伤的准确性较高，并提示预后不良。

Objective To assess the significance of serum cysteine proteinase inhibitor C （Cys-C） andβ2microglobulin （β2MG） concentrations in the diagnosis and prognosis of sepsis-induced acute kidney injury. Methods Two hundred and fifty patients presenting to the Emergency Department of Beijing Chaoyang Hospital from October 2008 to October 2009 with sepsis were assessed. Serum creatinine （SCr） ,β2MG and Cys-C concentrations and Acute Physiology and Chronic Health Evaluation II （ APACHE II ） scores were determined when the septic patients presented to the hospital. The 28-day mortality was recorded. The study patients were retrospectively divided into acute kidney injury （n = 63 ） and no acute kidney injury groups （n = 187 ）. The predictive accuracies of Cys-C and β2MG for acute kidney injury were analyzed by plotting a relative operating characteristic （ROC） curve. The Spearman interclass correlation method was used to analyze the correlation between Cys-C concentration and APACHE I1 score in sepsisinduced acute kidney injury. Results Cys-C and β2MG concentrations were significantly greater in the acute than in the no acute kidney injury group [ （ 1189 ±214） μg/L vs. （678 ±118） μg/L, P =0. 007 ; （3705 ±599）μg/L vs. （2365 ±446） μg/L, P =0. 004, respectively]. SCr concentrations and APACHE II scores were significantly greater in the acute than in the no acute kidney injury group [ （145 ±49） vs. （73 ±25）, P =0. 013, （19 ±4） vs. （13±4）, P =0. 016]. There was a significant correlation between Cys-C concentration and APACHEII score in the acute kidney injury group （P 〈0. 01 ）. The 28-day mortality was significantly greater in the acute than in the no acute kidney injury group. The areas under the ROC curve for Cys-C and β2MG concentrations were 0. 909 （ OR = 1. 006, 95% CI = 1.002 - 1.009） and 0. 82 （ OR = 1.001, 95% CI = 1. 000 - 1.001）, respectively. Conclusions Monitoring of Cys-C and β2MG concentrations can effectively predict the occurrence of acute kidney injury in septic patients. Cys-C concentration is a more accurate predictor of this diagnosis than β2MG concentration. An increasing Cys-C concentration is an indicator of poor prognosis.