尿液肌动蛋白作为脓毒症相关急性肾损伤的生物标志物研究

Urinary actin as a biomarker of sepsis-associated acute kidney injury

目的探讨将患者尿液肌动蛋白作为脓毒症相关急性肾损伤(saAKI)的生物标志物的有效性。方法采用前瞻性、开放、单中心临床研究方法,选择2020年1月至2021年12月在我院急性确诊的非AKI的脓毒症患者(非AKI脓毒症组,n=20)以及saAKI患者(saAKI组,n=45)入组,另选取同时期正常人群(n=25)作为对照组。所有脓毒症患者根据“脓毒症-3”标准和改善全球肾脏病预后组织(KDIGO)的分类标准进行分类。在入院后24 h内、入院后第2日上午和入院后第3日上午3个时间点采集患者血液和尿液,进行血常规以及外周肌动蛋白浓度ELISA检测。收集入组的临床病理信息,与血清和尿液肌动蛋白水平进行比较,并通过受试者工作特征曲线评估血清和尿液肌动蛋白作为saAKI诊断指标的有效性。结果在随访采样的3 d时间内,与对照组相比,非AKI脓毒症组和saAKI组尿液肌动蛋白水平在3个时间点均存在显著差异(P<0.01),组间也均存在显著差异(P<0.01)。根据KDIGO指南分级说明对45例saAKI患者进行分级后,各等级组间尿液肌动蛋白水平和肌动蛋白/肌酐比值均存在显著差异(P<0.01)。入院后24 h内脓毒症患者样本的尿液肌动蛋白(AUC=0.887,P<0.01)和血浆肌酐(AUC=0.865,P<0.01)可以用于诊断区分AKI和非AKI状态。结论尿液肌动蛋白水平可以作为saAKI患者血清肌酐以外补充诊断的生物标志物,而较高的尿液肌动蛋白水平也反映了AKI的严重程度。

Objective To investigate the effectiveness of urinary actin as a biomarker of sepsis-related acute kidney injury(saAKI).Methods The study was designed according to a prospective,open,single-center clinical study method.Acute non-AKI patients(non-AKI sepsis group,n=20)and saAKI patients(saAKI group,n=45)in our hospital from January 2020 to December 2021 were enrolled in this study,and normal people(n=25)in the same period were selected as the control group.All patients with sepsis were classified according to the“Sepsis-3”criteria and the Kidney Disease:Improving Global Outcomes(KDIGO)classification criteria.Blood and urine were collected within 24 h after admission,on the morning of the second day after admission and the morning of the third day after admission for routine blood,and ELISA test was used to detect peripheral actin concentration.The clinicopathological information of patients was collected and compared with serum and urinary actin levels,and the effectiveness of serum and urinary actin as diagnostic indicators of saAKI was assessed by the receiver operator characteristic curve.Results Within 3 d of follow-up sampling,compared with the control group,urinary actin levels in the non-AKI sepsis group and the saAKI group were significantly different(P<0.01)at three time points,and there were also significant differences between the two groups(P<0.01).After grading 45 saAKI patients according to KDIGO guideline,urinary actin levels and actin/creatinine ratios were significantly different among all grading groups(P<0.01).Urinary actin(AUC=0.887,P<0.01)and plasma creatinine(AUC=0.865,P<0.01)from sepsis patients within 24 h after admission could be used to diagnose and distinguish AKI from non-AKI.Conclusion Urinary actin levels can be used as a biomarker for supplementary diagnosis in addition to serum creatinine in saAKI patients,and higher urinary actin levels also reflect the severity of AKI.