去乙酰化酶与急性缺血性脑卒中患者急性肾损伤严重程度及预后的关系

Relationship between deacetylase Sirtuin 3,severity of acute kidney injury and prognosis in patients with acute ischemic stroke

目的研究去乙酰化酶(SIRT3)与急性缺血性脑卒中患者急性肾损伤(AKI)严重程度及预后的关系。方法收集本院重症医学科2015年10月至2019年12月72例急性缺血性脑卒中AKI患者纳为观察组,50例仅发生急性缺血性脑卒中者纳为对照组,根据KDIGO指南相关标准,将观察组分为1期组(n=32)、2期组(n=21)与3期组(n=19),分别比较观察组与对照组、观察组各期组间AKI患者血肌酐(SCr)、尿胱抑素C(CysC)、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及血清SIRT3水平,分析AKI患者血清SIRT3水平与其肾功能损伤生物标志物间的相关性,评估血清SIRT3对AKI患者预后的价值。结果观察组血SCr、尿CysC、尿NGAL、血清CsyC、血BUN及血清SIRT3水平均显著高于对照组(均P<0.05);随访发现,观察组存活56例,死亡16例。存活病例入组时,肾损伤生物标志物以及死亡血清SIRT3水平均显著低于死亡组(均P<0.05);相关性分析提示患者血清SIRT3水平与其肾功能损伤生物标志物SCr、血清Cscy、血BUN、尿CsyC及尿NGAL水平均呈明显正相关(r=0.54,0.63,0.44,0.37,0.41,均P<0.05);ROC曲线显示,当血清SIRT3超过52.79 ng/L时,其在预测AKI患者院内死亡中的AUC=0.706,95%CI(0.548~0.865),灵敏度、特异度分别为68.6%和80.40%。结论血清SIRT3与急性缺血性脑卒中AKI的发生及发展密切相关,其血清浓度能有效反映AKI病情严重程度,并在预测患者院内死亡中具有较高的应用价值。

Objective To investigate the relationship between the deacetylase Sirtuin 3(SIRT3),severity of acute kidney injury(AKI)and prognosis in patients with acute ischemic stroke.Methods Seventy-two acute ischemic stroke patients with AKI treated in our Department of Critical Care Medicine between October 2015 and December 2019 were enrolled as the study group.Fifty patients with acute ischemic stroke alone were enrolled as the control group.Based on relevant criteria of KDIGO guidelines,the study group was further divided into stage 1 group(n=32),stage 2 group(n=21),and stage 3 group(n=19).The levels of serum creatinine(SCr),urinary cystatin C(CysC),urinary neutrophil gelatinase-associated lipocalin(NGAL)and serum SIRT3 were measured and compared between the study and control groups,and also between patients with different stages of AKI in the study sub-groups.The correlation between serum SIRT3 and biomarkers of renal impairment in AKI patients was analyzed.The prognostic value of serum SIRT3 in patients with AKI was evaluated.Results The levels of blood SCr,urinary CysC,urinary NGAL,serum CysC,blood BUN,and serum SIRT3 in the study group were significantly higher than those in the control group(all P<0.05).During the follow-up,56 patients of the study group survived and 16 died.The surviving patients had significantly lower levels of renal impairment biomarkers and serum SIRT3 than the dead patients at the time of study enrollment(P<0.05).Correlation analysis showed that the serum SIRT3 level in these patients was significantly positive-correlated with the biomarkers of renal injury such as SCr,serum CysC,blood BUN,urinary CysC,and urinary NGAL levels(r=0.54,0.63,0.44,0.37,and 0.41,all P<0.05).ROC curve analysis showed that a serum SIRT3 level>52.79ng/L predicted in-hospital death of AKI patients with an AUC of 0.706[95%CI(0.548~0.865)],a sensitivity of 68.6%and a specificity of 80.40%,respectively.Conclusion Serum SIRT3 is closely associated with development and progression of AKI in acute ischemic stroke.The serum SIRT3 level can effectively reflect the severity of AKI,and therefore is highly valuable in predicting in-hospital deaths.