胶原凝集素11在脓毒症急性肾损伤中的表达及临床意义

Expression and clinical significance of collectin11in sepsis-induced acute kidney injury

目的探讨天然免疫分子胶原凝集素11(CL-11)在脓毒症急性肾损伤(AKI)患者血清中的表达水平及其与脓毒症AKI患者预后的关系。方法选取脓毒症AKI患者共65例及健康对照组30例,留取患者血液、尿液标本及相关临床资料,测定脓毒症AKI各期患者APACHE-Ⅱ评分、血肌酐、CL-11、尿肾损伤因子-1水平及是否需肾脏替代治疗,记录患者的临床预后及需肾脏替代者的肾脏替代治疗持续时间,分析各组间的差异,比较脓毒症AKI患者基线(入组第一日)血清CL-11水平与临床预后及其他相关指标的关系。结果脓毒症AKI患者血清CL-11水平较健康对照组显著升高(P<0.01);脓毒症AKI患者血清CL-11水平随AKI分期加重而升高(AKI各分期间比较,P均<0.05)。血清CL-11基线的水平升高可增加脓毒症AKI患者病死率(P<0.05)及需肾脏替代治疗的可能性(P<0.05);进一步研究发现,血清CL-11基线水平与经典的AKI损伤标志物尿肾脏损伤因子-1及肾脏替代治疗持续时间呈正相关。结论血清CL-11介导的天然免疫反应参与了脓毒症AKI的发病过程,血清CL-11基线水平可能与脓毒症AKI患者预后有关。

Objective To investigate the expression and clinical significance of collectin11（CL-11）in sepsis-induced acute kidney injury（AKI）patients.Methods In this study,65 AKI patients and30 healthy individuals were included.Serum CL-11 levels in AKI patients at days 1,3 and 7,and urine kidney injury molecule-1（KIM-1）levels in both AKI patients and controls were examined.The AKI stage,serum creatinine（SCr）,duration of renal replacement therapy（RRT）and prognosis were analyzed.Results Serum CL-11 level in sepsis-induced AKI patients was significantly higher than in the healthy controls（P〈0.01）.Serum CL-11 levels were correlated to the progression of AKI with a peak at day 3.Furthermore,the baseline serum CL-11 level was higher in patients who subsequently died.Baseline serum CL-11 levels were positively correlated with the urine KIM-1 levels,AKI stage and RRT duration.Conclusions Elevated serum CL-11 was associated with worse AKI clinical outcomes.This finding suggests that CL-11 may be useful as a biomarker of AKI prognosis.