血清MCP-1、TRAF-6水平在脓毒症严重程度和急性肾损伤评估的作用

Role of serum MCP-1 and TRAF-6 levels in assessment of sepsis severity and acute kidney injury

目的探讨血清单核细胞趋化蛋白-1(MCP-1)、肿瘤坏死因子受体相关因子-6(TRAF-6)水平在脓毒症严重程度和急性肾损伤评估中的作用。方法回顾性分析2021年6月至2022年6月在新疆维吾尔自治区人民医院重症医学科接受治疗的110例脓毒症患者的病例资料,依据脓毒症相关急性肾损伤发生情况分为发生组(50例)、未发生组(60例)。统计分析两组患者基线资料、血清MCP-1、TRAF-6水平,并分析脓毒症患者血清MCP-1、TRAF-6水平与序贯多器官功能障碍(SOFA)评分、急性生理和慢性健康Ⅱ(APACHEⅡ)评分的相关性,多因素Logistic回归分析脓毒症相关急性肾损伤影响因素。结果110例患者中,脓毒症相关急性肾损伤发生50例,未发生60例,发生率为45.45%。发生组患者的高血压、肺部感染比例均高于未发生组(P<0.05),SOFA评分、APACHEⅡ评分均高于未发生组(P<0.05),氧合指数低于未发生组(P<0.05),肾小球滤过率(eGFR)、血肌酐(SCr)、尿素氮(BUN)水平均高于未发生组(P<0.05),动脉血乳酸水平高于未发生组(P<0.05),但两组患者的性别、年龄、糖尿病比例的差异无统计学意义(P>0.05)。发生组患者的血清MCP-1、TRAF-6水平均高于未发生组(P<0.05)。脓毒症患者血清MCP-1、TRAF-6水平与SOFA评分、APACHEⅡ评分均呈显著的正相关关系(P<0.05)。多因素Logistic回归分析显示,脓毒症相关急性肾损伤影响因素包括高血压、肺部感染、SOFA评分、APACHEⅡ评分、肾小球滤过率(eGFR)、动脉血乳酸、MCP-1、TRAF-6(P<0.05),不包括氧合指数、尿素氮(BUN)、SCr(P>0.05)。结论血清MCP-1、TRAF-6水平和脓毒症严重程度和关系密切,可作为急性肾损伤的诊断参考指标。

Objective To investigate the role of serum levels of monocyte chemoattractant protein-1(MCP-1)and tumor necrosis factor receptor-associated factor-6(TRAF-6)in the assessment of sepsis severity and acute kidney injury.Methods The research retrospectively reviewed the medical records of 110 patients with sepsis who were treated at the Department of critical care medicine of the hospital from June 2021 to June 2022,and the patients were divided into two groups according to the occurrence of sepsis-related acute kidney injury(50 patients)and the nonoccurrence group(60 patients).Statistical analysis baseline data,serum MCP-1,and TRAF-6 levels were analyzed in the two cohorts,and correlations between serum MCP-1 and TRAF-6 levels and sequential multiple organ dysfunction(sofa)scores,acute physiology and chronic healthⅡ(APACHEⅡ)score in patients with sepsis,and influencing factors for sepsis-related acute kidney injury were analyzed by multivariate Logistic regression.Results 110 patients,sepsis-associated acute kidney injury occurred in 50,did not occur in 60,and occurred in 45.45%.The patients in incidence group had a higher proportion of hypertension and pulmonary infection than those in the non-incidence group(P<0.05),higher SOFA score and APACHEⅡscore than those in the incidence group(P<0.05),lower oxygenation index(P<0.05),higher glomerular filtration rate(EGFR),serum creatinine(SCR)and urea nitrogen(BUN)levels than those in the incidence group(P<0.05),and higher arterial blood lactate levels than those in the non-incidence group(P<0.05).The difference in the proportion of diabetes mellitus was not statistically significant(P>0.05).Serum levels of MCP-1 and TRAF-6 were higher in patients in the incidence group than in the non-incidence group(P<0.05).There were significant correlations between serum MCP-1 and TRAF-6 levels and SOFA score and APACHEⅡscore in patients with sepsis(P<0.05).Multiple Logistic regression analysis showed that the factors influencing sepsis-related acute kidney injury included hypertension,lung infection,SOFA score,APACHEⅡscore,EGFR,arterial blood lactate,MCP-1,and TRAF-6(P<0.05),but it did not include oxygenation index,bun,and SCR(P>0.05).Conclusions serum MCP-1 and TRAF-6 levels and sepsis severity and relationship are close and can be used as diagnostic reference markers for acute kidney injury.