肾阻力指数及生物标志物对脓毒症患者发生急性肾损伤的早期预测价值

Comparison of renal resistance index and biomarkers in predicting acute kidney injury in patients with sepsis

目的:比较肾阻力指数(RRI)、血浆中性粒细胞明胶酶相关脂蛋白(pNGAL)及血浆前脑啡肽(pPENK)对于脓毒症患者发生急性肾损伤(AKI)的早期预测价值,发现对脓毒症患者AKI早期预测的最佳方法。方法:测量入组脓毒症患者6 h内的RRI,检测pNGAL、pPENK水平,根据入组患者7 d内是否发生AKI分成2组:AKI组和未发生AKI(N-AKI)组,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价3个指标对于脓毒症患者发生AKI的早期预测价值。结果:RRI(AUC=0.762)在脓毒症患者发生AKI的早期预测中优于pNGAL(AUC=0.714)。RRI联合pNGAL预测AKI的准确性(AUC=0.790)高于单一指标,但两者差异无统计学意义(P>0.05)。pPENK在AKI组和N-AKI组中比较,差异无统计学意义(P>0.05);进一步剔除肿瘤患者后发现,pPENK在AKI组中明显高于N-AKI组,差异有统计学意义(P<0.05)。结论:在脓毒症患者发生AKI的早期预测中,RRI的检测准确性优于pNGAL,RRI联合pNGAL并不明显优于单一指标。在肿瘤患者中,pPENK对于脓毒症AKI的早期预测受到限制。

Objective: Objective to compare the early predictive value of renal resistance index(RRI), plasma neutrophil gelatinase associated lipoprotein(pNGAL) and plasma preenkephalin(pPENK) for acute kidney injury(AKI) in patients with sepsis, and to find the best method for early prediction of AKI in patients with sepsis. Methods: The patients were divided into two groups: AKI group and no AKI(N-AKI) group according to the occurrence of AKI within 7 days. The receiver operating characteristic curve(ROC) was drawn to evaluate the early predictive value of the three indicators for AKI in patients with sepsis. Results: RRI(AUC=0.762) was better than pNGAL(AUC=0.714) in the early prediction of AKI in sepsis patients. The accuracy of RRI combined with pngal in predicting AKI(AUC=0.790) was higher than that of single index, but the difference between them was not statistically significant(P>0.05). There was no significant difference between the two groups(P>0.05), but after further removal of tumor patients, it was found that the difference of pepink in AKI group was significantly higher than that in N-AKI group(P<0.05). Conclusion: In the early prediction of AKI in patients with sepsis, the accuracy of RRI is better than pngal, and the combination of RRI and pNGAL is not significantly better than a single index. In cancer patients, the early prediction of septic AKI by pPENK is limited.