尿毒症性脑病的危险因素及相关炎症因子的预测价值

Risk factors for uremia encephalopathy and predictive value of related inflammatory factors

目的探讨尿毒症性脑病的危险因素及相关炎症因子的预测价值。方法选取2017年1月-2019年1月在本院治疗的尿毒症性脑病患者87例(观察组),同时选取单纯尿毒症患者170例作为对照组,比较两组临床资料差异,检测脑脊液肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-1β(IL-1β)水平。结果观察组定期血滤或灌流比例,明显低于对照组(P<0.05),而合并感染、抗生素使用、血钾<3.5 mmol/L、CO2结合力<10 mmol/L和血肌酐>1000μmol/L比例,明显高于对照组(P<0.05);Logistic回归分析结果显示:定期血滤或灌流、感染、抗生素使用和血钾<3.5 mmol/L是尿毒症性脑病的影响因素(OR值分别为0.717、2.186、2.438和2.177,P<0.05);观察组脑脊液TNF-α、IL-6和IL-1β明显高于对照组(P<0.05);脑脊液TNF-α、IL-6和IL-1β判断尿毒症性脑病的ROC曲线下面积分别为0.740、0.705和0.764(P<0.05)。结论尿毒症性脑病发生受多种因素影响,临床诊治时应加以重视,患者脑脊液TNF-α、IL-6和IL-1β水平升高,在尿毒性脑病诊断中有一定作用。

Objective To explore the risk factors for uremia encephalopathy and predictive value of related inflammatory factors.Methods A total of 87 patients with uremic encephalopathy in our hospital from January 2017 to January 2019 were selected(observation group),170 patients with simple uremia were selected as control group,the difference of clinical data between the two groups were compared,the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-1β(IL-1β)in cerebrospinal fluid were measured.Results The proportion of regular hemofiltration or perfusion in the observation group was 11.49%,which was significantly lower than that in the control group(P<0.05),the rates of combined infection,antibiotic use,blood potassium<3.5 mmol/L,carbon dioxide binding<10 mmol/L and creatinine>1000μmol/L were significantly higher than those of the control group(P<0.05);Logistic regression analysis showed that regular hemofiltration or perfusion,infection,antibiotic use and blood potassium<3.5 mmol/L were the influencing factors of uremic encephalopathy(OR=0.717,2.186,2.438 and 2.177,P<0.05);the cerebrospinal fluid TNF-α,IL-6 and IL-1βin the observation group were significantly higher than those in the control group(P<0.05);the area under ROC curve of cerebrospinal fluid TNF-α,IL-6 and IL-1βjudgment of uremic encephalopathy were 0.740,0.705 and 0.764(P<0.05).Conclusion The occurrence of uremic encephalopathy is affected by many factors,which should be paid attention to in clinical diagnosis and treatment.The elevated levels of TNF-α,IL-6 and IL-1βin patients'cerebrospinal fluid play a certain role in the diagnosis of uremic encephalopathy.