脓毒症性急性肾损伤患者CD_4^+ T淋巴细胞内三磷酸腺苷水平变化及其与肾功能转归的关系

Changes of CD_4^+ T Cell Intracellular ATP Level of Patients With Septic Acute Kidney Injury and Its Relation With Renal Function Outcome

目的探讨CD_4^+T淋巴细胞内三磷酸腺苷(CD_4^+T cell-iATP)水平预测脓毒症并发急性肾损伤(AKI)患者预后的价值。方法前瞻性选择2013年7月—2014年12月于丽水市中心医院ICU、感染科及肾内科住院的脓毒症并发AKI患者69例为研究对象,分别于人组0、48、96h检测患者CD_4^+T cell-iATP水平。根据肾功能临床转归情况将患者分为肾功能完全恢复组(18例)、肾功能部分恢复组(38例)、依赖透析组(4例)和死亡组(9例)。结果各组eGFR、功能衰竭脏器数量、AKI分期及0、48h CD_4^+T cell-iATP水平比较,差异有统计学意义(P<0.05)。多分类Logistic回归分析结果显示,相对于预后不良(依赖透析或死亡),eGFR、功能衰竭脏器数量和48h CD_4^+T cell-iATP水平为肾功能完全恢复、肾功能部分恢复的影响因素(P<0.05)。ROC曲线分析显示,48h CD_4^+T cell-iATP水平预测脓毒症并发AKI患者预后的ROC曲线下面积为0.926(P<0.01),取48h CD_4^+T cell-iATP临界点为344.2μg/L时,灵敏度为92.3%,特异度为87.5%。结论 CD_4^+T cell-iATP水平低的脓毒症患者肾功能恢复良好,脓毒症患者早期CD_4^+T cell-iATP水平是肾功能转归的预测指标。

Objective To investigate the value of CD4＋T cell-iATP level in the prediction of the prognosis of sepsis patients complicated with acute kidney injury（AKI）.Methods From July 2013 to December 2014,a total of 69 sepsis inpatients complicated with AKI in the ICU,the Department of Infectious Disease and Nephrology in Lishui Center Hosipital were enrolled in this prospective study.The levels of CD4＋T cell-iATP at 0 h,48 h and 96 h after onset of SIAKI were detected.According to the prognosis of acute kidney injury（AKI）,the subjects were divided into four groups：complete renal recovery group（18 cases）,partial renal recovery group（38 cases）,dialysis dependency group（4 cases） and death group（9cases）.Results The four groups were significantly different in estimated glomerular filtation rate（eGFR）,the number of visceral organs with function failure,and numbers of patient in each stage of AKI and the levels CD4＋ T cell-iATP at 0 and 48 h（P〈0.05）.Multivariable Logistic regression analysis indicated that eGFR,the number of visceral organ with function failure and the levels of CD4＋ T cell-iATP（48 h） were influencing factors for the complete recovery and partial recovery of renal function（P〈0.05）,compared with unfavorable prognosis（dialysis dependency or death）.ROC curve analysis showed that the AUC of CD4＋T cell-iATP（48 h） predicting the prognosis of sepsis patients complicated with AKI was 0.926（P〈0.01）,with a sensitivity and a specificity as 92.3%and 87.5%respectively at a critical point of 344.2μg/L for CD4＋T cell-iATP（48 h）level.Conclusion Sepsis patients with lower CD4＋ T cell-iATP level have better recovery of renal function,and CD4＋ T cell-iATP level of patients with early- stage sepsis may serve as a predictor for the renal function outcome.