血肌酐、血清TOLL样受体4及尿肾损伤分子-1对脓毒血症患者急性肾损伤的预测价值

The predictive value of serum creatinine, Toll like receptor 4 and kidney injury molecule-1 on acute kidney injury in septic patients

目的 探讨血肌酐(Scr)、血清TOLL样受体4(TLR4)、尿肾损伤分子-1(KIM-1)对脓毒血症患者急性肾损伤(AKI)的预测价值。方法 选取60例脓毒血症患者为研究对象,根据是否合并AKI将其分为合并AKI组(n=28)、非AKI组(n=32)。分析脓毒血症患者合并AKI的风险因素,评估Scr、TLR4及KIM-1水平对脓毒血症患者AKI的预测效能。结果 单因素及多因素logistic回归结果显示,APACHEⅡ评分、SOFA评分及Scr、血清TLR4、尿KIM-1水平是脓毒血症患者发生AKI的危险因素(P<0.05)。ROC分析结果显示,当Scr≥112.045μmol/L时,预测脓毒血症患者AKI的敏感度为67.9%,特异度为71.9%;当TLR4≥3.760 ng/ml时,敏感度为71.4%,特异度为68.8%;当KIM-1≥18.930 pg/L时,敏感度为75.0%,特异度为71.9%;三者联合预测的敏感度为85.7%,特异度为75.0%。结论 Scr、血清TLR4及尿KIM-1水平升高是脓毒血症患者合并AKI的影响因素,可将其用于脓毒血症患者合并AKI的辅助预测手段,且三者联合具有更优的预测效能。

Objective This paper aims to investigate the predictive value of serum creatinine(Scr), Toll like receptor 4(TLR4) and kidney injury molecule-1(KIM-1) in acute kidney injury(AKI) in septic patients. Methods Sixty patients with sepsis were selected as the study objects. They were divided into two groups according to whether they were combined with AKI, including the combined AKI group(n=28) and non-AKI group(n=32). The risk factors of AKI in sepsis patients were analyzed to evaluate the predictive efficacy of Scr, TLR4 and KIM-1 levels on AKI in sepsis patients. Results Univariate and multivariate logistic regression results showed that APACHE Ⅱ score, SOFA score, Scr, TLR4, KIM-1 levels were risk factors for AKI in septic patients(P<0.05). ROC analysis results show that when Scr was ≥112.045 μmol/L, the sensitivity and specificity of predicting AKI in septic patients were 67.9% and 71.9% respectively. When TLR4 was ≥3.760 ng/ml, the sensitivity was 71.4%, and the specificity was 68.8%. When KIM-1 was ≥18.930 pg/L, the sensitivity was 75.0%, and the specificity was 71.9%. The sensitivity and specificity of the combined prediction were respectively 85.7% and 75.0%. Conclusion The increase of Scr, TLR4 and KIM-1 levels is an influencing factor for septic patients with AKI, which can be used as an auxiliary predictor for septic patients with AKI, and the combination of the three has a better predictive efficacy.