基于改善全球肾脏病预后组织分期启动连续性肾脏替代治疗对急性肾损伤患者自噬相关蛋白表达及预后的影响

The effect of continuous renal replacement therapy based on kidney disease improving global outcomes organization staging on autophagy-related proteins expression and its relationship with the prognosis in the treatment of patients with acute kidney injury

目的探讨基于改善全球肾脏病预后组织(KDIGO)分期启动连续性肾脏替代治疗(CRRT)对急性肾损伤(AKI)患者微管相关蛋白1轻链3-Ⅱ(LC3-Ⅱ)、自噬相关蛋白5(ATG5)和自噬基因Beclin-1表达及预后的影响。方法选取2019年1月至2020年12月80例在绍兴市中心医院诊断为AKI并接受CRRT治疗的患者作为研究对象,依据KDIGO-AKI标准将患者分为Ⅰ期(24例)、Ⅱ期(26例)和Ⅲ期(30例),比较三组一般资料及预后情况,并采用多因素Logistic回归分析影响患者预后的危险因素。结果三组患者年龄、CRRT治疗时间、ICU住院时间、平均动脉压、血乳酸(Lac)和24 h乳酸清除率(24 h LCR)比较差异无统计学意义(P>0.05)。三组LC3-Ⅱ(1.13±0.11、1.47±0.23、1.66±0.19)、ATG5(1.24±0.26、1.48±0.17、1.62±0.16)和Beclin-1(1.23±0.15、1.51±0.12、1.71±0.13)表达比较差异有统计学意义(P<0.05)。三组28 d存活率和住院病死率比较差异有统计学意义(P<0.05),Ⅲ期患者28 d存活率最低,住院病死率最高。多因素Logistic回归分析结果显示LC3-Ⅱ、Beclin-1表达和AKI分级是影响AKI患者28 d存活率和住院病死率的危险因素(P<0.05)。结论基于KDIGO分期启动CRRT治疗AKI能改善患者预后,自噬因子LC3-Ⅱ、Beclin-1和AKI分期是影响患者预后的危险因素。

Objective To investigate the effect of continuous renal replacement therapy(CRRT)based on kidney disease improving global outcomes organization(KDIGO)staging on mononuclear cell microtubule-associated protein 1 light chain 3-Ⅱ(LC3-Ⅱ),autophagy related protein 5(ATG5)and autophagy genes Beclin-1 in the treatment of patients with acute kidney injury(AKI)and its relationship with prognosis.Methods Eighty patients who were diagnosed with AKI and treated with CRRT in Shaoxing Central Hospital from January 2019 to December 2020 were selected as the research object.According to the KDIGO-AKI standard,they were divided into stageⅠ(24 cases),stageⅡ(26 cases)and stageⅢ(30 cases).The prognosis,general data,autophagy related molecular mRNA levels were compared among the three groups and multivariate Logistic regression was used to analyze the risk factors of the prognosis of patients.Results The age,CRRT treated time,ICU stay time,mean arterial pressure,blood lactic acid and 24 hlactate clearance rate in three groups had no significant differences(P>0.05).The levels of LC3-Ⅱin the three group were 1.13±0.11,1.47±0.23,1.66±0.19,and the levels of ATG5 in the three group were 1.24±0.26,1.48±0.17,1.62±0.16,the levels of Beclin-1 in three group were 1.23±0.15,1.51±0.12,1.71±0.13,there were statistical differences(P<0.05).The 28 d survival rate and the hospital mortality rate in the three group had significant differences(P<0.05),the patients in the stageⅢgroup had lowest 28 d survival rate and highest hospital mortality rate.Multivariate Logistic regression analysis results showed that LC3-Ⅱ,Beclin-1 levels and AKI grading were the risk factors affecting the 28 d survival rate and the hospital mortality rate.Conclusions Starting CRRT based on KDIGO stage in the treatment of AKI can improve the prognosis of patients,and autophagy factor LC3-Ⅱ,Beclin-1 and AKI stage are risk factors affecting the prognosis of patients.