全身性感染急性肾损伤患者C反应蛋白和降钙素原动态变化的临床研究

Clinical study on the dynamic changes of C-reactive protein and procalcitonin in patients with acute kidney injury caused by systemic infection

目的探究全身性感染急性肾损伤(AKI)患者C反应蛋白和降钙素原动态变化。方法2018年5月~2021年4月,医院收治了85例出现感染症状的急诊患者。测定降钙素原(PCT)、血清淀粉样蛋白A(SAA)、白细胞计数(WBC)的水平,并连续3 d监测参与者的肾功能。结果经过诊断,确诊AKI患者有12例,发生率为14.12%。入组时,AKI组的PCT、SAA、CRP、IL-6以及WBC水平显著高于非AKI组(P<0.05)。PCT≤0.5 ng/L组、0.5 ng/L<PCT≤2 ng/L组,2 ng/L<PCT≤10 ng/L组和PCT>10 ng/L组之间AKI发生率、肾功能指标,包括血清尿素、肌酐和胱抑素C水平差异均有统计学意义(P<0.001)。PCT、IL-6、CRP、WBC和SAA在可疑感染患者中预测AKI的AUC=0.830、0.695、0.647、0.607和0.549,对于具有感染症状患者预测AKI的有效性最高。结论PCT可以作为全身性感染急性肾损伤的预测指标。

Objective To explore the dynamic changes of C-reactive protein and procalcitonin in patients with acute kidney injury caused by systemic infection.Methods From May 2018 to April 2021,85 inpatients with symptoms of infection were admitted to the hospital.Measure the levels of PCT,serum amyloid A(SAA),C-reactive protein(CRP),interleukin 6(IL-6)and white blood cell count(WBC),and monitor the kidney function of the participants for 3 consecutive days.Results After diagnosis,12 patients were diagnosed with AKI,and the incidence rate was 14.12%.At enrollment,the levels of PCT,SAA,CRP,IL-6 and WBC in the AKI group were significantly higher than those in the non-AKI group(P<0.05).AKI incidence and renal function indexes between PCT≤0.5 ng/L group,0.5 ng/L<PCT≤2 ng/L group,2 ng/L<PCT≤10 ng/L group and PCT>10 ng/L group,including serum urea,creatinine and cystatin C levels were significantly different(P<0.001).PCT,IL-6,CRP,WBC and SAA predicted AKI in patients with suspected infection AUC=0.830,0.695,0.647,0.607 and 0.549.PCT was most effective in predicting AKI in patients with infectious symptoms.Conclusion PCT can be used as a predictor of acute kidney injury caused by systemic infection.