血清TLR4、MFG-E8及HMGB1对脓毒症患者并发急性肾损伤的诊断价值

Diagnostic value of serum TLR4,MFG-E8 and HMGB1 in patients with sepsis complicated with acute renal injury

目的探讨外周血Toll样受体4(TLR4)、乳脂球表皮生长因子8(MFG-E8)及高迁移率族蛋白B1(HMGB1)水平对脓毒症患者并发急性肾损伤(AKI)的诊断价值。方法选择脓毒症患者130例,根据KGIDO标准将患者分为AKI组63例、非AKI组67例。采用ELISA法检测血清TLR4、MFG-E8、HMGB1,并收集相关指标。采用单因素和多因素Logistic回归分析脓毒症患者并发AKI的危险因素;采用受试者工作特征(ROC)曲线评价血清TLR4、MFG-E8、HMGB1水平对脓毒症患者并发AKI的诊断价值。结果AKI组血清TLR4、HMGB1水平高于非AKI组,血清MFG-E8水平低于非AKI组(P均<0.05)。AKI组序贯器官衰竭评分、基线血肌酐、基线eGFR、乳酸水平高于非AKI组,血清白蛋白水平低于非AKI组(P均<0.05);两组其他指标比较差异均无统计学意义(P均>0.05)。AKIⅢ期的脓毒症患者TLR4、HMGB1水平比较:AKIⅢ期>AKIⅡ期>AKIⅠ期;MFG-E8水平比较:AKIⅢ期<AKIⅡ期<AKIⅠ期。两两比较差异均有统计学意义(P均<0.05)。TLR4、HMGB1水平升高是脓毒症患者并发AKI的危险因素(OR均>1,P均<0.05),MFG-E8水平升高是脓毒症患者并发AKI的保护因素(OR>1,P<0.05)。TLR4、HMGB1及MFG-E8联合检测诊断脓毒血症患者并发AKI的曲线下面积大于三者单独检测(P均<0.05)。结论脓毒症并发AKI的患者血清TLR4、HMGB1水平升高,MFG-E8水平降低,三者水平变化可反映患者肾损伤程度,有助于脓毒症并发AKI的早期诊断。

Objective To investigate the diagnostic value of serum toll-like receptor 4(TLR4),milk fat globule epidermal growth factor-8(MFG-E8)and high-mobility group protein B1(HMGB1)in patients with sepsis complicated with acute renal injury(AKI).Methods Totally 130 patients with sepsis were divided into the AKI group of 63 cases and non-AKI group of 67 cases according to KGIDO standard.The serum TLR4,MFG-E8 and HMGB1 were detected by ELISA,and the related indexes were collected.Univariate and multivariate Logistic regression were used to analyze the risk factors for sepsis patients complicated with AKI.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum TLR4,MFG-E8 and HMGB1 in patients with sepsis complicated with AKI.Results The levels of TLR4 and HMGB1 were higher in the AKI group than in the non-AKI group,and the level of MFG-E8 was lower in the AKI group than in the non-AKI group(P<0.05).SOFA score,baseline serum creatinine,baseline eGFR and lactic acid levels were higher in the AKI group than in the non-AKI group,while serum albumin level was lower than that of the non-AKI group(all P<0.05).There was no significant difference in other indexes between the two groups(all P>0.05).Comparison of TLR4 and HMGB1 levels in patients with AKIⅢsepsis was in the following order:AKIⅢ>AKIⅡ>AKIⅠ,MFG-E8 level comparison:AKIⅢ<AKIⅡ<AKIⅠ,with statistically significant difference(all P<0.05).The increased TLR4 and HMGB1 levels were the risk factors for AKI in sepsis patients(OR>1,P<0.05),while the increased MFG-E8 level was protective factor for AKI in sepsis patients(OR>1,P<0.05).The area under the curve of combined detections ofTLR4,HMGB1 and MFG E8 in diagnosing sepsis with AKI was 0.932(95%CI:0.910-0.979),the sensitivity was 0.93,the specificity was 0.98,and the accuracy was 0.95,which were higher than those of the three alone(all P<0.05).Conclusion The levels of TLR4 and HMGB1 of patients with sepsis complicated with AKI increase,while the level of MFG-E8 decreases,which can reflect the degree of renal injury and help the early diagnosis of sepsis complicated with AKI.