血清增殖诱导配体水平与脓毒症急性肾损伤的关系

The relationship between serum proliferation-inducing ligand level and sepsis-induced acute kidney injury

目的 探讨分析血清增殖诱导配体水平与脓毒症急性肾损伤的关系。方法 选取2020年10月~2021年10月保定市第一中心医院收治的106例脓毒症患者,入院时取患者空腹静脉血清标本,采用酶联免疫吸附法检测血清增殖诱导配体(a proliferation inducing ligand,APRIL)水平,根据血清APRIL表达中位数13.42(7.38,19.65)μg/L将患者分为血清APRIL高表达组(43例)和血清APRIL低表达组(63例)。分析血清APRIL表达水平与脓毒症急性肾损伤的关系。结果 血清APRIL高表达和低表达组患者性别、年龄、白细胞计数、C反应蛋白、降钙素原、胱抑素C、肌酐清除率、急性生理与慢性健康状况评分Ⅱ(acute physiologic and chronic health evaluation,APACHEⅡ)评分、机械通气、肾替代治疗、血清APRIL水平存在显著差异(χ^(2)/t=4.068、2.678、2.746、9.816、18.915、12.515、6.021、10.130、19.063、9.012、3.176,P=0.044、0.009、0.007、<0.001、<0.001、<0.001、<0.001、<0.001、<0.001、0.003、<0.001)。血清APRIL高表达组急性肾损伤发生率39.53%高于血清APRIL低表达组的19.05%,提示血清APRIL表达水平与脓毒症急性肾损伤有关(χ^(2)=5.398,P<0.001)。多因素Logistic回归分析结果显示:胱抑素C(OR=1.906,95%CI:1.219~2.980,P=0.005)、肌酐清除率升高(OR=2.067,95%CI:1.271~3.360,P=0.003)、APACHEⅡ评分≥12分(OR=6.290,95%CI:2.671~14.813,P<0.001)、血清APRIL升高(OR=6.848,95%CI:2.510~18.681,P<0.001)是脓毒症急性肾损伤的独立影响因素。结论 脓毒症急性肾损伤患者血清增殖诱导配体水平升高是脓毒症急性肾损伤的重要危险因素,与急性肾损伤发生密切相关。

Objective To explore the relationship between serum a proliferation-inducing ligand (APRIL) level and sepsis-induced acute kidney injury.Methods A total of 106 patients with sepsis admitted to Baoding First Central Hospital from October 2020 to October 2021 were selected.Fasting venous serum samples were collected from patients at admission,and serum APRIL was measured by enzyme-linked immunosorbent assay.According to the median serum APRIL level of 13.42 (7.38,19.65)μg/L,the patients were divided into high APRIL group (n=43) and low APRIL group (n=63).The relationship between serum APRIL level and sepsis-induced acute kidney injury was analyzed.Results Gender,age,white blood cell count,C-reactive protein,procalcitonin,cystatin C,creatinine clearance rate,APACHE Ⅱ score,mechanical ventilation,renal replacement therapy,and serum APRIL level were significantly different between high APRIL group and low APRIL group (χ~2=4.068,t=2.678,2.746,9.816,18.915,12.515,6.021,10.130,19.063,9.012 and 3.176 respectively;P≤0.05,0.044,0.009,0.007,<0.001,<0.001,<0.001,<0.001,<0.001,0.003 and<0.001 respectively).The incidence of acute kidney injury was 39.53%in high APRIL group and was 19.05%in low APRIL group (χ~2=5.398,P=0.000),suggesting that serum APRIL level is correlated with sepsis-induced acute kidney injury.Multivariate logistic regression showed that cystatin C (OR=1.906,95%CI:1.219~2.980,P=0.005),increased creatinine clearance rate (OR=2.067,95%CI 1.271~3.360,P=0.003),APACHEⅡscore≥12(OR=6.290,95%CI 2.671~14.813,P<0.001),and increased serum APRIL (OR=6.848,95%CI 2.510~18.681,P<0.001) were the independent influencing factors for sepsis-induced acute kidney injury.Conclusion The increased serum APRIL in patients with sepsis-induced acute kidney injury is an important risk factor for these patients.Higher serum APRIL is closely related to the occurrence of acute kidney injury in sepsis patients.