血清H-FABP、肾阻力指数与脓毒症患者并发急性肾损伤的关系

Relationships between serum H-FABP,renal resistance index and acute kidney injury in patients with sepsis

目的探讨血清心型脂肪酸结合蛋白(H-FABP)、肾阻力指数(RRI)对脓毒症患者并发急性肾损伤(AKI)的关系及其预测能效。方法选取197例脓毒症患者,根据是否并发AKI分为AKI组(n=81)和非AKI组(n=116)。对比两组患者基线资料、血清H-FABP水平和RRI,多因素Logistics回归分析脓毒症并发AKI影响因素,ROC曲线分析血清H-FABP水平和RRI对脓毒症并发AKI的预测价值。结果AKI组中心静脉压(CVP)、血肌酐(SCr)、血尿素氮(BUN)、血乳酸(BLA)、降钙素原(PCT)、H-FABP水平和RRI高于非AKI组(P均<0.05)。多因素Logistics回归分析显示,CVP(OR=1.127,95%CI:1.021~1.243)、SCr(OR=1.025,95%CI:1.012~1.038)、BLA(OR=1.462,95%CI:1.097~1.948)、PCT(OR=1.115,95%CI:1.009~1.232)、H-FABP(OR=1.394,95%CI:1.201~1.618)、RRI(OR=1.530,95%CI:1.372~1.973)为脓毒症并发AKI独立危险因素(P均<0.05)。ROC曲线显示,H-FABP+RRI(ROC曲线下面积=0.859,95%CI:0.802~0.904)预测脓毒症并发AKI的敏感度和特异度高于H-FABP(ROC曲线下面积=0.773,95%CI:0.708~0.829)、RRI(ROC曲线下面积=0.744,95%CI:0.677~0.803)。结论脓毒症并发AKI患者血清H-FABP水平和RRI升高,为并发AKI独立危险因素,H-FABP联合RRI可提高预测脓毒症并发AKI的价值。

Objective To investigate the relationships between serum heart-type fatty acid binding protein(HFABP),renal resistance index(RRI) and acute kidney injury(AKI) in patients with sepsis and their predictive energy efficiency.Methods Totally 197 patients with sepsis were divided into the AKI group(n=81) and non-AKI group(n=116).The baseline data,serum H-FABP level and RRI of the two groups of patients were compared.Multivariate Logistics regression analysis was used to analyze the influencing factors of sepsis complicated with AKI,the ROC curve was used to analyze the predictive value of serum H-FABP level and RRI for sepsis complicated with AKI.Results Central venous pressure(CVP),blood creatinine(SCr),blood urea nitrogen(BUN),blood lactate(BLA),procalcitonin(PCT),H-FABP levels and RRI in the AKI group were significantly higher than those in the non-AKI group(all P<0.05).Multivariate Logistic regression analysis showed that CVP(OR=1.127,95%CI:1.021-1.243),SCr(OR=1.025,95%CI:1.012-1.038),BLA(OR=1.462,95%CI:1.097-1.948),PCT(OR=1.115,95%CI:1.009-1.232),H-FABP(OR=1.394,95%CI:1.201-1.618),and RRI(OR=1.530,95%CI:1.372-1.973) were independent risk factors for sepsis complicated with AKI(all P<0.05).The ROC curve showed that the sensitivity and specificity of H-FABP+RRI(AUC=0.859,95%CI:0.802-0.904) in predicting sepsis complicated with AKI were higher than those of H-FABP(AUC=0.773,95%CI:0.708-0.829) and RRI(AUC=0.744,95%CI:0.677-0.803).Conclusion The serum HFABP level and RRI of patients with sepsis complicated with AKI significantly increase,which are independent risk factors for AKI,and H-FABP combined with RRI can increase the value of predicting sepsis complicated with AKI.