黏附因子联合肾阻力指数对早期预测脓毒症患者发生急性肾损伤的价值

Value of renal resistance index and serum cell adhesion molecules for prediction of acute kidney injury in patients with sepsis

目的探讨联合应用肾阻力指数(RI)和黏附因子对早期预测脓毒症患者发生急性肾损伤(AKI)的临床意义。方法选择2019年6月-2020年3月入住河北医科大学第三医院重症医学科的脓毒症成年患者66例,同期非脓毒症患者34例作为对照组。收集患者基线资料,使用床旁超声检测患者RI,采用酶联免疫吸附测定法(ELISA)测定血浆E-选择素(CD62E),L-选择素(CD62L)和P-选择素(CD62P)及细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)及白细胞介素-6(IL-6),白细胞介素-1(IL-1),肿瘤坏死因子-α(TNF-α)。应用Logistic回归分析AKI危险因素,接受者操作特征曲线(ROC)分析RI、黏附因子、RI联合黏附因子对预测感染性休克患者发生AKI的价值。结果AKI组的CD62L、CD62E、ICAM及VCAM均较非AKI组升高,差异具有统计学意义(P<0.05)。Logistics回归分析显示,黏附因子中仅AC62L[OR=1.055(1.009~1.104),P<0.05]及降钙素原[OR=1.076(1.018~1.138),P=0.009]是脓毒症患者发生AKI的独立危险因素。联合应用RI和CD62L预测脓毒症患者发生AKI的敏感度为73.30%,特异度为98.40%,曲线下面积(AUC)为0.86(0.79~0.93),约登指数为0.717。结论CD62L是脓毒症相关性肾损伤的独立危险因素,以RI为0.67、CD62L=45.69 pg/ml为界值可以作为临床预测脓毒症患者发生AKI的早期预测指标,黏附因子联合RI可早期预测脓毒症患者发生AKI的风险。

OBJECTIVE To explore the value of renal resistance index(RI)and serum cell adhesion molecules for the early prediction of acute kidney injury(AKI)in patients with sepsis.METHODS Sixty-six patients with sepsis in intensive care unit ICU at the 3 rd HospitaL of Hebei Medical University from Jun 2019 to Mar 2020 were enrolled in the septic AKI group;another 34 patients without sepsis during the same period were divided into the control group.Subjects’general information was collected.The value of RI was detected by ultrasonic at the bedside.Levels of CD62 E,CD62 L,CD62 P,adhesion molecules such as ICAM-1 and VCAM-1,IL-6,IL-1 and TNF-αwere detected by enzyme-link immunosorbent assay(ELISA).Risk factors of AKI were analyzed by multivariate Logistic regression assay.And area under the receiver operating characteristic(ROC)curves were used to analyze the predictive value of RI,serum cell adhesion molecules and the combination of RI and adhesion molecules on the occurrence of AKI.RESULTS Levels of CD62 L,CD62 E,ICAM,VCAM,IL-6,IL-1 and TNF-αin the septic AKI group were significantly higher than that in the non-AKI group at two time points(days 1 and 3).Logistic regression analysis showed that CD62 L(OR=1.055,P<0.05)and procalcitonin(OR=1.076,P=0.0091)were independently associated with septic AKI.The sensitivity and specificity of the combined detection of RI and CD62 L in predicting AKl were 73.30%and 98.40%,respectively,with the AUC of 0.86(0.79-0.93)and Youden index of 0.717.CONCLUSION High CD62 L level was the independent risk factor of the development of AKI in patients with sepsis.The predictive cut-off values were 0.67 for RI and 45.69 pg/ml for CD62 L.Combination of RI and CD62 L could have a practical predictive value of AKI in patients with sepsis.