血浆可溶性白细胞分化抗原14早期预测脓毒症患者发生急性肾损伤的价值

Value of soluble leukocyte differentiation antigen 14 to the early prediction of acute kidney injury in patients with sepsis

目的观察脓毒症患者血浆可溶性白细胞分化抗原14(soluble leukocyte differentiation antigen 14,sCD14)水平变化,探讨其对脓毒症患者发生急性肾损伤(acute kidney injury,AKI)的早期预测价值。方法脓毒症患者80例,发生AKI者58例为AKI组,未发生AKI者22例为非AKI组。比较2组入住ICU 24 h内急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health scoring systemⅡ,脓毒症休克比率55.17%,APACHEⅡ)评分、序贯器官衰竭(sequential organ failure assessment,SOFA)评分及入住ICU次日血浆sCD14、血清降钙素原、乳酸、肌酐、白细胞介素-6、C反应蛋白水平,估算肾小球滤过率,入住ICU 24 h尿量;绘制ROC曲线,评估血浆sCD14对脓毒症患者发生AKI的预测价值。结果AKI组血浆sCD14[705.37(428.11,925.96)ng/L],血清肌酐[120.88(101.07,130.35)μmol/L]、降钙素原[6.85(2.89,18.22)μg/L]、乳酸[(5.58±2.13)mmol/L]、C反应蛋白[(156.33±31.55)mg/L]、白细胞介素-6[(162.11±47.03)ng/L]水平,脓毒性休克比率(55.17)%,APACHEⅡ评分[(21.63±8.91)分]和SOFA评分[(8.56±1.35)分]均高于非AKI组[350.62(285.37,403.05)ng/L、108.56(95.25,118.24)μmmol/L、2.72(1.42,9.67)μg/L、(3.71±1.21)mmol/L、(76.83±18.82)mg/L、(132.99±34.68)ng/L、27.27%、(16.81±7.73)分、(6.92±1.23)分](P<0.05),估算肾小球滤过率[48.67(37.75,72.52)mL/(min·1.73 m^(2))]低于非AKI组[76.52(61.25,87.52)mL/(min·1.73 m^(2))](P<0.05),2组男性比率、年龄、脓毒症病因、脓毒症及重度脓毒症比率、入住ICU 24 h尿量与非AKI组比较差异均无统计学意义(P>0.05)。血浆sCD14、血清肌酐、估算肾小球滤过率分别以389.77 ng/L、119.79μmol/L、65.63 mL/(min·1.73 m^(2))为最佳截断值,预测脓毒症患者发生AKI的AUC分别为0.811(95%CI:0.708~0.890,P<0.001)、0.672(95%CI:0.558~0.773,P=0.011)、0.739(95%CI:0.629~0.831,P<0.001),灵敏度分别为81.03%、53.45%、72.41%,特异度分别为77.27%、81.82%、77.27%。血浆sCD14预测脓毒症患者发生AKI的AUC大于血清肌酐(Z=2.044,P=0.041),与估算肾小球滤过率比较差异无统计学意义(Z=0.815,P=0.415)。结论脓毒症患者发生AKI的早期血浆sCD14水平增高,其灵敏度、特异度均高于血清肌酐。

Objective To observe the changes of plasma soluble leukocyte differentiation antigen 14(sCD14)in patients with sepsis,and to investigate the value of sCD14to the early prediction of acute kidney injury(AKI)in patients with sepsis.Methods Eighty patients with sepsis were divided into AKI group(n=58)and non-AKI group(n=22).The acute physiology and chronic health scoring system Ⅱ(APACHEⅡ)score and sequential organ failure assessment(SOFA)score in 24hafter entering ICU,the levels of plasma sCD14,serum procalcitonin,lactate,serum creatinine,interleukin-6(IL-6)and C-reactive protein on the second day after entering ICU,estimated glomerular filtration rate(eGFR)and 24-h urine volume after entering ICU were compared between two groups.ROC curve was drawn to evaluate the value of plasma sCD14level and creatinine to the prediction of AKI in patients with sepsis.Results The levels of plasma sCD14,serum creatinine,procalcitonin,lactate,C-reactive protein,IL-6,incidence of septic shock,APACHEⅡ and SOFA were higher in AKI group[705.37(428.11,925.96)ng/L,120.88(101.07,130.35)μmol/L,6.85(2.89,18.22)μg/L,(5.58±2.13)mmol/L,(156.33±31.55)mg/L,(162.11±47.03)ng/L,55.17%,21.63±8.91,8.56±1.35]than those in non-AKI group[350.62(285.37,403.05)ng/L,108.56(95.25,118.24)μmmol/L,2.72(1.42,9.67)μg/L,(3.71±1.21)mmol/L,(76.83±18.82)mg/L,(132.99±34.68)ng/L,27.27%,16.81±7.73,6.92±1.23](P<0.05),eGFR was lower in AKI group[48.67(37.75,72.52)mL/(min·1.73m^(2))]than that in non-AKI group[76.52(61.25,87.52)mL/(min·1.73 m^(2))](P<0.05),and there were no significant differences in the male ratio,age,etiology of sepsis,percentages of patients with sepsis and severe sepsis,and 24-h urine volume after entering ICU between two groups(P>0.05).When the optimal cut-off values of plasma sCD14,serum creatinine and eGFR were 389.77ng/L,119.79μmol/L and 65.63mL/(min·1.73m^(2)),the AUCs for predicting AKI in patients with sepsis were 0.811(95%CI:0.708-0.890,P<0.001),0.672(95%CI:0.558-0.773,P=0.011)and0.739(95%CI:0.629-0.831,P<0.001),the sensitivities were 81.03%,53.45% and 72.41%,and the specificities were 77.27%,81.82% and 77.27%,respectively.The AUCof plasma sCD14for predicting AKI in patients with sepsis was greater than that of serum creatinine(Z=2.044,P=0.041),and showed no significant difference compared with eGFR(Z=0.815,P=0.415).Conclusion The plasma sCD14level increases in the early stage of AKI in patients with sepsis,and it has higher sensitivity and specificity than serum creatinine.