血清Nod样蛋白受体3、白介素-18水平与脓毒症急性肾损伤患者病情严重程度的相关性

Correlation between serum NOD-like receptor protein 3,interleukin-18 and severity of septicacute kidney injury

目的探讨脓毒症急性肾损伤(AKI)患者血清Nod样蛋白受体蛋白3(NLRP3)、白介素-18(IL-18)水平与病情严重程度的相关性。方法选择2018年10月至2020年8月宁夏医科大学总医院ICU住院治疗的56例脓毒症患者,依据诊断标准将患者分为脓毒症组(26例)和脓毒症AKI组(脓毒症轻度AKI20例,重度AKI 10例),选取同期30例健康体检者作为对照组,分别收集并比较各组一般资料,依据28 d病死率将患者分为存活组(30例)与死亡组(26例),检测和比较各组血清中NLRP3、IL-18水平,分析血清NLRP3、IL-18与尿NGAL、Kim-1的相关性。分析影响患者预后的危险因素,绘制受试者工作特征曲线(ROC),评价独立危险因素单独及联合应用的预测价值。结果与对照组比,脓毒症组与脓毒症AKI组NLRP3、IL-18水平升高(P<0.05),与脓毒症轻度AKI组比,脓毒症重度AKI组NLRP3、IL-18水平升高(P<0.05)。与死亡组比,存活组NLRP3、IL-18水平降低(P<0.05),NLRP3、IL-18与尿NGAL、Kim-1均呈正相关。多因素logistic回归分析显示:血清NLRP3水平是影响脓毒症AKI死亡的独立因素。ROC曲线分析显示:NLRP3、APACHEⅡ评分单独预测脓毒症28 d病死率的AUC分别为0.72、0.73,敏感度分别为80%、85%,联合预测的AUC为0.78,敏感度为95%,优于单一指标(P<0.05)。结论血清NLRP3、IL-18水平与脓毒症AKI患者病情严重程度密切相关。

Objective To investigate the correlation between serum NOD-like receptor protein 3(NLRP3and interleukin-18(IL-18)and the severity of septic acute kidney injury(AKI).Methods In this prospective study,56 patients with sepsis who were hospitalized in the ICU of the General Hospital of Ningxia Medical University from October 2018 to August 2020 were selected and divided into the sepsis group(26 cases)and sepsis AKI group(20 cases of mild AKI and10 of severe AKI)according to the Kidney Disease Improving Global Outcomes(KDIGO)diagnostic criteria,and 30 healthy subjects in the same period were selected as control group.The general data of each group were collected and compared.According to the 28-day mortality rate,the patients were divided into survival group(n=30)and death group(n=26).The level of serum NLRP3 and IL-18 was detected and compared,and the correlation between serum NLRP3,IL-18 and urine NGAL and Kim-1 was analyzed.Risk factors affecting the prognosis of patients with sepsis AKI were analyzed,and receiver operating characteristic curve(ROC)was drawn to evaluate the predictive value of independent risk factors alone and in combination.Results Compared with that in the control group,the level of NLRP3 and IL-18 in sepsis group and sepsis AKI group was higher than that in sepsis mild AKI group,and the level of NLRP3 and IL-18 in sepsis severe AKI group was higher than that in sepsis mild AKI group(P<0.05).Compared with that in the death group,the level of NLRP3 and IL-18 in the survival group was lower,and the level of NLRP3 and IL-18 was positively correlated with urinary NGAL and Kim-1.Multivariate logistic regression analysis showed that serum NLRP3 was an independent factor affecting the death of sepsis AKI(P<0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of NLRP3 and APACHEⅡscore for predicting 28-day mortality of sepsis was 0.72 and 0.73,and the sensitivity was 80%and 85%respectively.AUC of the combined detection of the above two indexes was 0.78,and the sensitivity was 95%,which was better than that of the single indicator(P<0.05).Conclusion The level of serum NLRP3 and IL-18 is closely related to the severity of AKI patients with sepsis.