血清高迁移率族蛋白1及白细胞介素-18对老年脓毒症并发急性肾损伤患者的预后评估价值

Prognostic value of serum HMGB1 and IL-18 in elderly patients with sepsis com plicated with acute kidney injury

目的探讨血清高迁移率族蛋白1(HMGB1)及白细胞介素-18(IL-18)对老年脓毒症并发急性肾损伤(AKI)患者的预后评估价值.方法选取2016年1月至2018年12月海南省第三人民医院收治的老年脓毒症并发AKI患者248例,根据是否死亡分为存活组(n=157)和死亡组(n=91).按AKI分期标准分为AKI 1期(n=105)、AKI 2期(n=86)和AKI 3期(n=57).采用酶联免疫吸附法检测各组血清HMGB1及IL-18水平.应用受试者工作特征(ROC)曲线分析血清HMGB1及IL-18水平对老年脓毒症并发AKI患者预后的价值.结果死亡组血清HMGB1(μg/L:176.40±27.80 vs.108.52±21.46)及IL-18(ng/L:96.70±12.46 vs.70.84±8.25)水平均明显高于存活组(P<0.05).AKI3期血清HMGB1(μg/L:194.35±30.26 vs.102.35±21.70、121.60±23.48)及IL-18(ng/L:105.74±15.26 vs.68.30±8.42、75.20±8.27)水平明显高于AKI 1期和AKI 2期(P<0.05).ROC曲线分析显示,血清HMGB1及IL-18水平评估老年脓毒症并发AKI患者死亡的最佳截断值分别为142.50μg/L、85.62 ng/L,两项联合评估老年脓毒症并发AKI患者死亡的AUC(0.904,95%CI0.842~0.961)最大,其敏感度和特异度为92.5%和84.6%.Pearson相关分析显示,死亡组血清HMGB1与IL-18呈正相关(r=0.743,P<0.01).结论血清HMGB1及IL-18水平在死亡患者中明显升高,两项联合对评估老年脓毒症并发AKI患者死亡具有较高的价值.

Objective To investigate the progmostic value of serum high mobility group protein 1(HMGB1)and interleukin-18(IL-18)in elderly patients with sepsis complicated with acute kidney injury(AKI).Methods A total of 248 elderly sepsis patients with AKI admited to the Third People's Hospital of Hainan Province from January 2016 to December 2018 were selected and divided into survival group(n=157)and death group(n=91)according to their mortality.According to AKI staging criteria,they were divided into AKI 1(n=105),AKI2(n=86)and AKI3(n=57).Serum levels of HMGB1 and IL-18 were measured by ELISA.The prognostic value of serum HMGB1 and IL-18 levels in elderly patients with sepsis complicated with AKI was analyzed by ROC curve.Results The serum levels of HMGB1(μg/L:176.40±27.80 vs.108.52±21.46)and IL-18(ng/L:96.70±12.46 vs.70.84±8.25)in the death group were significantly higher than those in the survival group(P<0.05).Serum levels of HMGBI(μg/L:194.35±30.26 vs.102.35±21.70,121.60±23.48)and IL-18(ng/L:105.74±15.26 vs.68.30±8.42,75.20±8.27)in AKI stage 3 were significantly higher than those in AKI stage 1 and AKI stage 2(P<0.05).ROC curve analysis showed that the best cut-off values of serum HMGB1 and IL-18 levels for evaluating the mortality of elderly sepsis complicated with AKI were 142.50 ug/L and 85.62 ng/L,respectively.The AUC(O.904,95%CI 0.842~0.961)of elderly sepsis complicated with AKI was the highest in the two combined assessments,with the sensitivity and specificity of 92.5%and 84.6%,Pearson correlation analysis showed that serum HMGB1 was positively correlated with IL-18 in the death group(r=0.743,P<0.01).Conclusion Serum HMCB1 and IL-18 levels are significantly inereased in patients with death,and the two combined tests,are of high value in the evaluation of death in elderly sepsis complicated with AKI.