血浆肝素结合蛋白对脓毒症相关急性肾损伤的早期诊断及预后预测

Analysis of the value of plasma heparin binding protein in the early diagnosis and prognosis of sepsis associated acute kidney injury

目的:评价血浆肝素结合蛋白(HBP)与血清胱抑素C(sCys C)、尿N-乙酰-β-D-氨基葡萄糖苷酶(uNAG)相比,对脓毒症相关急性肾损伤(S-AKI)的早期诊断价值,同时评价血浆HBP与APACHEⅡ评分对脓毒症并发AKI患者28 d死亡风险的早期预测价值。方法:选择2019年7月—2020年12月在潍坊医学院附属医院重症医学科诊断为脓毒症的患者96例,根据患者是否并发急性肾损伤(AKI)分为两组:AKI组58例和非AKI组38例,并对脓毒症并发AKI的患者进行KDIGO分级。使用多因素Logistic回归分析影响S-AKI发生的风险因素;Spearman相关系数计算血浆HBP、sCys C、uNAG与S-AKI患者KDIGO分期的关系;绘制ROC曲线评价血浆HBP、sCys C、uNAG对S-AKI的预测价值,计算截断值及约登指数。根据脓毒症并发AKI患者28 d是否存活分为存活组与死亡组,绘制ROC曲线评估血浆HBP与APACHEⅡ评分对S-AKI患者28 d死亡的早期预测价值。结果:血浆HBP、sCys C、uNAG是S-AKI发生的风险因素(P<0.05);血浆HBP、sCys C、uNAG与S-AKI患者KDIGO分期呈正相关关系(P<0.001),且血浆HBP与分期的相关性最高,相关系数为0.877;sCys C、uNAG和血浆HBP及三者联合检测预测S-AKI的AUC依次为0.879、0.884、0.896、0.939,HBP截断值为65.895 ng/mL时,其约登指数为0.664,综合诊断价值最高;ROC曲线显示APACHEⅡ评分、HBP以及二者联合预测S-AKI患者预后的AUC依次为0.767、0.817、0.837。结论:HBP作为S-AKI的生物标志物,与sCys C、uNAG相比,对脓毒症相关AKI的预测价值最高,三者联合检测时能更进一步提高预测价值;HBP联合APACHEⅡ评分对S-AKI患者死亡风险有较好的早期预测价值。

Objective: To evaluate the value of plasma heparin-binding protein(HBP) in the early diagnosis of sepsis associated acute kidney injury(S-AKI) compared with serum cystatin C(sCys C) and urinary N-acetyl-β-D-glucosaminosidase(uNAG). Meanwhile, to evaluate the value of plasma heparin-binding protein combined with APACHE Ⅱscore in early prediction of 28-day mortality in patients with S-AKI. Methods: A total of 96 patients diagnosed with sepsis in the Department of Critical Care Medicine, Affiliated Hospital of Weifang Medical University from July, 2019 to December, 2020 were selected. According to whether the patients were complicated with AKI or not, they were divided into AKI group(n=58) and non-AKI group(n=38), and patients with sepsis complicated with AKI were classified by KDIGO. Multivariate logistic regression was used to analyze the risk factors affecting the occurrence of S-AKI;Spearman correlation coefficient was used to calculate the relationship between plasma HBP, sCys C, uNAG and KDIGO staging of S-AKI patients. ROC curves were drawn to evaluate the predictive value of plasma HBP, sCys C and uNAG on S-AKI. Calculate the cut off value and the Yoden index. The patients with S-AKI were divided into survival group and death group according to whether they survived at 28 days. The ROC curve was drawn to evaluate the early predictive value of plasma HBP and APACHE Ⅱ score for 28-day death of S-AKI patients. Results: Plasma HBP, sCys C and uNAG were risk factors for the occurrence of S-AKI(P<0.05). Plasma HBP, sCys C and uNAG were positively correlated with KDIGO staging in patients with S-AKI(P<0.001), and the correlation between plasma HBP and staging was the highest, with a correlation coefficient of 0.877. The AUC of S-AKI were predicted to be 0.879, 0.884, 0.896 and 0.939 by sCys C, uNAG, plasma HBP and the combined detection of the three respectively. When the cut-off value of HBP was 65.895 ng/mL, the Youden index was 0.664, and the comprehensive diagnostic value was the highest. The ROC curve showed that the AUC of APACHE Ⅱ score, HBP and their combination in predicting the prognosis of S-AKI patients were 0.767, 0.817 and 0.837, respectively. Conclusion: As a biomarker of S-AKI, HBP has the highest predictive value for sepsis associated AKI compared with sCys C and uNAG, and the combined detection of the three can further improve the predictive value;HBP combined with APACHE Ⅱscore has a good value for early prediction of mortality risk in patients with S-AKI.