血清PCT、hs- CRP及Th17细胞对脓毒症相关急性肾损伤患者行连续肾脏替代治疗法结局的预测价值

Predictive value of serum PCT, hs-CRP, and Th17 cell in the outcome ofcontinuous renal replacement therapy in patients with acute renal injury caused by sepsis

目的:探究血清降钙素原(procalcitonin, PCT)、超敏C-反应蛋白(hypersensitive C-reactive protein, hs-CRP)及Th17细胞对脓毒症相关急性肾损伤(sepsis associated acute kidney injury, SA-AKI)患者行连续肾脏替代治疗法(continuous renal replacement therapy, CRRT)结局的预测价值。方法:选择本院2021年1月至2022年10月就诊的211例SA-AKI患者,根据治疗策略差异分为观察组(n=84)和对照组(n=127)。对照组给予常规治疗,观察组接受CRRT治疗。对比两组治疗前、治疗72 h后生化标志物(PCT、hs-CRP、Th17细胞)水平。观察组以首次CRRT治疗28 d后生存状态为分组标准,再分为死亡组、存活组。对比观察组不同预后患者临床特征,采用受试者工作特征(receiver operator characteristic curve, ROC)曲线分析PCT、hs-CRP、Th17细胞预测SA-AKI患者CRRT治疗预后价值。结果:治疗后观察组PCT、hs-CRP、Th17细胞水平明显低于对照组(P<0.05)。84例观察组中存活56例,死亡28例;两组年龄、ICU住院时间、PCT、hs-CRP、Th17细胞、APACHEⅡ、SOFA评分特征对比,差异有统计学意义(P<0.05)。年龄、ICU住院时间、PCT、hs-CRP、Th17细胞、APACHEⅡ评分为CRRT治疗后不良预后独立危险因素(P<0.05)。ROC曲线分析显示,PCT、hs-CRP、Th17细胞联合预测SA-AKI患者CRRT治疗预后不良的AUC为0.864(95%CI:0.775~0.923),均高于其他单一生物标志物诊断(P<0.05);其敏感度、特异度分别为85.69%、79.41%。结论:PCT、hs-CRP、Th17细胞对SA-AKI患者CRRT治疗结局的预测有一定价值。

Objective:To explore the predictive value of serum procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),and Th17 cell on the outcome of continuous renal replacement therapy(CRRT)in patients with sepsis associated acute renal injury(SA-AKI).Methods:211 patients with SA-AKI who visited our hospital from January 2021 to October 2022 were selected and divided into an observation group(n=84)and a control group(n=127)based on the differences in treatment strategies.The control group received routine treatment,while the observation group received CRRT treatment.The levels of biochemical markers(PCT,hs-CRP,Th17 cell)were compared between the two groups before and 72 hours after treatment.Based on the survival status 28 days after the first CRRT treatment,they were divided into death group and survival group.To compare the clinical characteristics of patients with different prognosis in the observation group,the receiver operator characteristic curve(ROC)curve was used to analyze the predictive value of PCT,hs-CRP,and Th17 cell in predicting the prognosis of CRRT treatment in SA-AKI patients.Results:After treatment,the levels of PCT,hs-CRP,and Th17 cell in the observation group were significantly lower than those in the control group(P<0.05).Among 84 cases in the observation group,56 cases were in the survival group and 28 cases were in the death group.There was a significant difference between the two groups in terms of age,length of stay in ICU,PCT,hs-CRP,Th17 cell,APACHEⅡ,SOFA scores(P<0.05).ROC curve results showed that the AUC of PCT,hs-CRP,Th17 cell jointly predicting poor prognosis of SA-AKI patients after CRRT treatment was 0.864(95%CI:0.775-0.923)higher than that of other single biomarkers(P<0.05).The sensitivity and specificity were 85.69%and 79.41%,respectively.Conclusion:PCT,hs-CRP,and Th17 cell are valuable in predicting the outcome of CRRT treatment in SA-AKI patients.