中性粒细胞明胶酶相关脂质运载蛋白联合白细胞介素-18在脓毒症急性肾损伤患者早期启动连续性肾脏替代治疗中的预测价值

Value of neutrophil gelatinase-associated lipocalin combined with interleukin-18 in predicting early use of CRRT among patients with AKI caused by sepsis

目的中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及白细胞介素-18(IL-18)对于脓毒症导致的急性肾损伤(AKI)患者中开展连续性肾脏替代治疗(CRRT)的预测价值。方法采用随机对照前瞻性研究方法,本研究选取2017年1月至2018年1月山西省人民医院重症医学病房收治的68例脓毒症引发AKI患者为研究对象,治疗采用《2016国际脓毒症和脓毒性休克处理指南》中治疗标准,入重症监护室(ICU)后连续监测72h,依据患者是否行CRRT治疗分为CRRT组与非CRRT组,观察并比较2组患者一般情况、血乳酸、急性生理及慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、序贯器官功能评分(SOFA评分)、NGAL水平及IL-18水平;观察NGAL、IL-18对于脓毒症导致的AKI患者中开展CRRT的预测价值。结果 2组相比较,早期传统指标血肌肝、尿素氮差异无统计学意义(281±66)μmol/L与(256±52)μmol/L,(19±4)mmol/L与17.4±4.4,P>0.05),而2组间早期新型指标NGAL、IL-18差异有统计学意义[(460±69)μg/L比(272±46)μg/L,(93±7)ng/L比(61±5)ng/L,P<0.05]。受试者工作持征曲线(ROC曲线)结果显示,NGAL预测脓毒症AKI患者早期CRRT治疗的受试者工作曲线下面积(AUC)为0.658,95%CI(0.526,0.790),IL-18的AUC为0.607,95%CI(0.467,0.746),而两者联合后的AUC最大,为0.828,95%CI(0.727,0.929)。结论 NGAL、IL-18对脓毒症AKI患者早期行CRRT治疗有预测价值,而两者联合预测价值更高。

Objective To value of neutrophil gelatinase-associated lipocalin (NGAL) combined with interleukin-18 in predicting early use of continuous renal replacement therapy(CRRT) among patients with AKI caused by sepsis. Methods A randomized controlled prospective study was conducted,including 68 AKI patients who were admitted to the ICU of Shanxi Provincial People′s Hospital between January 2017 and January 2018. According to the treatment protocolby the 2016 International Guidelines for the Treatment of Sepsis and Septic Shock,the patients were continuously monitored for 72 hours after ICU admission,and were divided into CRRT group and non-CRRT group according to whether the patients were treated with CRRT. The general conditions,blood lactate,acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ score),sequential organ function score (SOFA score),NGAL level and IL-18 level were recorded and compared between the two groups. The value of NGAL and IL-18 in predicting CRRT in sepsis-induced AKI patients was evaluated. Results Between the two groups,conventional indicators such as blood Crand BUN did not differ(281±66)μmol/L vs (256±52)μmol/L,(19±4)mmol/L vs (17±4)mmol/L,P>0.05) but the new indicators (NGAL,IL-18)were significantly different[(460±69)μg/L vs.(272±46)μg/L,(93±7)ng/L vs.(61±5)ng/L,P<0.05]early during the disease. ROC curve showed that the area under the curve (AUC) for NGAL in predicting early CRRT in septic AKI was[0.658,95%CI(0.526,0.790],and that for IL-18 was[0.607,95%CI(0.467,0.746)]. The AUC after combination of the two was the the largest[0.828,95%CI(0.727,0.929]. Conclusion NGAL and IL-18 are predictive for early useof CRRT in patients with septic AKI. Combination of the two can be even more predictive.