PCT、Lac、cTnI、cTnT及其联合检测对ICU脓毒症合并AKI患者的诊断价值

The Diagnostic Values of PCT,Lac,cTnI,cTnT and Their Combination on Patients with Sepsis Complicated with AKI in ICU

目的探究血清中降钙素原(PCT)、乳酸(Lac)、快速肌钙蛋白在重症监护病房(ICU)急性肾损伤(AKI)表达中的意义。方法回顾性分析我院ICU 116例脓毒症合并AKI患者(AKI组)及124例脓毒症未合并AKI患者(非AKI组)临床资料,比较两组基线资料及血清PCT、Lac、肌钙蛋白I(cTnI)、肌钙蛋白T(cTnT)水平差异,使用受试者工作曲线(ROC曲线)评估血清PCT、Lac、cTnI、cTnT及其联合检测对ICU脓毒症患者合并AKI的诊断价值;并根据AKI组患者改善全球肾脏病预后组织(KDIGO)分期分为Ⅰ期组、Ⅱ期组、Ⅲ期组3个亚组,分析ICU脓毒症合并AKI患者KDIGO分期与上述血清学指标的相关性。结果AKI组与非AKI组性别、年龄、入院主要急症、高血压、糖尿病等基线资料比较,差异无统计学意义(P>0.05);但AKI组慢性肾功能不全患病率、APACHEⅡ评分及血清PCT、Lac、cTnI、cTnT水平均高于非AKI组(P<0.05)。经ROC曲线分析,发现血清PCT、Lac、cTnI、cTnT及其联合检测均对ICU脓毒症患者合并AKI具有较高诊断价值(P<0.05),且联合检测诊断价值最高。经Spearman秩相关性分析,发现ICU脓毒症合并AKI患者KDIGO分期与血清PCT、Lac、cTnI、cTnT水平均呈显著正相关(r=0.358、0.491、0.411、0.402,P<0.05)。结论血清PCT、Lac、cTnI、cTnT水平可辅助临床尽早诊断ICU脓毒症患者合并AKI,并判断病情进展情况,指导临床诊疗。

Objective To explore the significance of expressions of serum procalcitonin(PCT),lactate(Lac)and rapid troponin in acute kidney injury(AKI)in the intensive care unit(ICU).Methods The clinical data of 116 patients with sepsis complicated with AKI(the AKI group)and 124 patients with sepsis but without AKI(the non-AKI group)from the ICU of our hospital were retrospectively analyzed.The baseline data and levels of serum PCT,Lac,cardiac troponin I(cTnI)and cardiac troponin T(cTnT)were compared between the two groups.Receiver operating characteristic curve(ROC curve)was used to evaluate the diagnostic values of serum PCT,Lac,cTnI,cTnT and their combined detection on AKI in patients with sepsis in ICU.According to the kidney disease:Improving Global Outcomes(KDIGO)staging of patients in the AKI group,they were divided into stage I,stage II and stage III subgroups.The correlation between KDIGO staging and the above-mentioned serological indicators was analyzed among patients with sepsis complicated with AKI in ICU.Results There were no statistical differences in the baseline data of gender,age,major emergencies after admission,hypertension and diabetes between the AKI group and non-AKI group(P>0.05).However,the prevalence rate of chronic renal insufficiency,APACHEⅡscore and levels of serum PCT,Lac,cTnI and cTnT in the AKI group were higher than those in the non-AKI group(P<0.05).ROC curve analysis showed that serum PCT,Lac,cTnI,cTnT and their combined detection had high diagnostic values on AKI in patients with sepsis in ICU(P<0.05),and combined detection had the highest diagnostic value.Spearman rank correlation analysis showed that the KDIGO staging of patients with sepsis complicated with AKI in ICU was significantly positively correlated with levels of serum PCT,Lac,cTnI and cTnT(r=0.358,0.491,0.411,0.402,respectively,all P<0.05).Conclusion Serum PCT,Lac,cTnI and cTnT levels can assist with clinical diagnosis of patients with sepsis complicated with AKI in ICU timely,also can facilitate the determination of the progress of the disease,and guide clinical diagnosis and treatment.