黏附因子联合肾阻力指数对脓毒症相关性肾损伤的早期肾功能恢复的预测价值

Value of adhesion factors and renal resistance index in the prediction of early renal function recovery of patients with sepsis-associated acute kidney injury

目的探讨联合应用黏附因子和肾阻力指数(renal resistace index,RRI)对脓毒症相关性急性肾损伤患者早期肾功能恢复的预测价值。方法选择河北医科大学第三医院重症医学科住院的脓毒症相关性肾损伤成年患者为研究对象,收集研究对象的一般资料,应用床旁超声检测患者RRI,采用酶联免疫吸附测定法测定血浆E-选择素、L-选择素和P-选择素及内皮细胞黏附因子(intercellular cell adhesion molecule-1,ICAM-1)及血管细胞黏附分子1(vascular cell adhesion molecule-1,VCAM-1)水平,对患者进行随访1个月,将研究对象根据入组30 d是否肾功能恢复作为标准,分为肾功能恢复组和肾功能未恢复组。应用Logistics回归分析方法及接受者操作特征(receiver operating characteristic,ROC)曲线分析RRI、黏附因子、RRI联合黏附因子对脓毒症急性肾损伤患者肾功能恢复的预测价值。结果共纳入脓毒症相关性急性肾损伤者78例,其中男性54例,女性24例,平均年龄(70.8±23.3)岁;脓毒症急性肾损伤早期肾功能恢复组的VCAM-1表达均低于肾功能未恢复组(P=0.0355),肾功能早期恢复组的APACHEⅡ评分及白细胞计数明显低于肾功能未恢复组(P<0.05)。应用ROC曲线分析,VCAM-1联合RRI预测脓毒症患者早期肾功能恢复的敏感度为90.9%,特异度为32.1%,AUC=0.68。结论VCAM-I联合RRI对于脓毒症相关性急性肾损伤患者的早期肾功能恢复有较高的预测价值,以肾脏阻力指数的界值为0.71,VCAM-1的界值为1233 ng/L,可以作为脓毒症相关性急性肾损伤患者的早期肾功能恢复的预测指标。

Objective To explore the predictive value of adhesion factors and renal resistance index(RRI)for early renal function recovery of patients with sepsis-associated acute kidney injury(AKI).Methods Patients with sepsis-associated AKI treated in the Third Hospital of Hebei Medical University were enrolled as research subjects.General information of patients was collected.The patient's RRI was detected by bedside ultrasound,and plasma E-selectin,L-selectin and P-selectin as well as the levels of endothelial cell adhesion molecule-1(ICAM-1)and vascular cell adhesion molecule-1(VCAM-1)were measured by enzyme-linked immunosorbent assay(ELISA).They were followed up for 1 month.With renal function recovery at 30 d after enrollment as the standard,the subjects were divided into the renal function recovery group and the non-renal function recovery group.Logistic regression analysis method and receiver operating characteristic(ROC)curve were used to analyze the predictive value of RRI,adhesion factor,RRI combined with adhesion factor in the recovery of renal function in patients with sepsis-associated AKI.Results A total of sepsis-associated AKI 78 patients,including 54 males and 24 females with a mean age of(70.8±23.3)years,were enrolled in this study.The expression of VCAM-1 in patients with sepsis-associated AKI was lower in the early renal function recovery group than in the non-renal function recovery group(P=0.0355).The APACHEⅡscore and white blood cell count of the early renal function recovery group were significantly lower than those of the non-renal function recovery group(P<0.05).According to ROC analysis,the sensitivity and specificity of VCAM-1 combined with RRI in predicting early renal function recovery were 90.9%and 32.1%respectively,with AUC=0.68.Conclusion Combination of RRI and VCAM-1 has a high predictive value for early renal function recovery of patients with sepsis-associated AKI.The threshold of RRI is 0.71,and the threshold of VCAM-1 is 1233 ng/L,which can be used as a predictor of early renal function recovery in patients with sepsis-associated AKI.