脓毒症合并急性肾损伤患者血清血管生成素2、正五聚蛋白3水平的研究

Plasma angiopoietin 2 and pentraxin 3 in patients with septic shock and acute kidney injury

目的:检测脓毒症及合并急性肾损伤(acute kidney injury,AKI)患者血清血管生成素(angiopoietin,Ang)2和正五聚蛋白(pentraxin,PTX)3水平,探讨其与脓毒症合并AKI的相关性。方法:采用回顾性队列研究方法,选取2017年5月至2018年9月在上海交通大学医学院附属瑞金医院重症监护病房(intensive care unit,ICU)诊断脓毒症24 h内的患者为研究对象(共40例),根据有无合并AKI分为脓毒症组和合并AKI组,并以术后存在感染患者作为对照组,对血浆中炎症因子Ang2、PTX3表达量进行比较。结果 :脓毒症组[(6 058±2 905)ng/L]、合并AKI组[(8 668±4 374)ng/L]血浆Ang2水平均显著高于术后组[(2 746±1 793)ng/L](P<0.05)。且血浆PTX3水平在脓毒症组[(8 746±8 383)ng/L]及合并AKI组[(15 623±12 022)ng/L]中显著高于术后组[(2 564±2 204)ng/L](P<0.05)。与脓毒症患者相比,合并AKI患者血浆Ang2、PTX3水平显著升高(P<0.05)。Ang2的受试者工作特征(receiver operating characteristic, ROC)曲线下面积为0.819 [95%可信区间(confidence interval,CI):0.712~0.900],灵敏度为94%,特异度为55%。PTX3的ROC曲线下面积为0.795 (95%CI:0.685~0.881),灵敏度为82%,特异度为73%。结论:血浆Ang2和PTX3水平在合并AKI患者中较单纯脓毒症患者显著升高。

Objective To determine the plasma level of angiopoietin 2(Ang2) and pentraxin 3(PTX3) in patients with sepsis and acute renal injury(AKI). Methods A total of 40 patients with sepsis in the intensive care unit(ICU) of Ruijin Hospital affliated to Shanghai Jiao Tong University School of Medicine from May 2017 through September 2018 were retrospectively analyzed. The patients were divided into sepsis group, sepsis complicated with AKI group and post-surgery group. The levels of plasma Ang2 and PTX3 were compared among the groups. Results Both plasma Ang2 and PTX3 levels were significantly higher in patients with sepsis [(6 058±2 905) ng/L,(8 746±8 383) ng/L] and with AKI complications[(8 668±4 374) ng/L,(15 623±12 022) ng/L] than those of post-surgery group [(2 746±1 793) ng/L(P<0.05) and(2 564±2 204) ng/L(P<0.05)]. The elevation of plasma Ang2 and PTX3 was also significantly higher in patients with sepsis complicated with AKI group(P<0.05). The area under receiver operating characteristic(AUROC) value of Ang2 is 0.819 [95% CI: 0.712-0.900] with a sensitivity of 94% and a specificity of 55%. The AUROC value of PTX3 was 0.795(95% CI: 0.685-0.881)with a sensitivity of 82% and a specificity of 73%. Conclusions The levels of plasma Ang2 and PTX3 tend to increase in patient with sepsis and trend is exacerbated with complication of AKI.