脓毒症患者血清NRF2、HO-1水平变化及对并发急性肾损伤的预测价值

Changes of serum NRF2 and HO-1 levels in patients with sepsis and their predictive value for the complication of acute kidney injury in these patients

目的探讨脓毒症患者血清核因子E2相关因子2(nuclea factor erythroid-2-related factor2,NRF2)、血红素氧合酶-1(heme oxygenase-1,HO-1)水平变化及对并发急性肾损伤(acute kidney injury,AKI)的预测价值。方法选取2017年4月—2023年4月南京中医药大学附属南京医院脓毒症患者132例为研究组,选取同期年龄、性别匹配的健康体检者132例为对照组。2组均检测血清NRF2、HO-1水平。统计研究组入院1周并发AKI情况,分析脓毒症患者并发AKI的影响因素,构建脓毒症患者并发AKI的列线图预测模型并进行决策曲线分析(decision curve analysis,DCA)。结果研究组血清NRF2(t=30.537,P<0.001)、HO-1(t=29.302,P<0.001)水平高于对照组;研究组132例脓毒症患者入院1周AKI发生率为45.45%(60/132);随着NRF2、HO-1水平升高,患者并发AKI发生率呈降低趋势(χ^(2)=35.636,28.514,均P<0.001);Logistic多因素回归分析提示NRF2(OR=0.104,95%CI:0.023~0.471,P=0.003)、HO-1(OR=0.341,95%CI:0.168~0.691,P=0.003)是脓毒症患者并发AKI的独立保护因素,脓毒症相关性器官功能衰竭评价评分(OR=1.493,95%CI:1.128~1.976,P=0.005)、降钙素原(OR=1.277,95%CI:1.070~1.523,P=0.007)、白细胞计数(OR=3.030,95%CI:1.550~5.921,P=0.001)是脓毒症患者并发AKI的独立危险因素;列线图预测模型显示NRF2、HO-1对脓毒症患者并发AKI具有较高预测价值,一致性指数分别为0.769、0.751;DCA显示在阈值0.20~0.78,联合评估脓毒症患者并发AKI的净受益率优于NRF2、HO-1单独检测。结论脓毒症患者血清NRF2、HO-1水平升高,联合检测二者水平有助于判断AKI发生风险。

Aim To investigate the changes of serum levels of nuclear factor E2-related factor 2(NRF2)and heme oxygenase-1(HO-1)in patients with sepsis and their predictive value for the complication of acute kidney injury(AKI)in these patients.Methods A total of 132 patients with sepsis treated in our hospital from April 2017 to April 2023 were selected as the study group,and a total of 132 healthy subjects with similar age and sex ratios during the same period were selected as the control group.Serum NRF2 and HO-1 levels were tested in both groups.AKI was evaluated in the study group at the first week after admission.The influencing factors of AKI in sepsis patients were analyzed.The nomogram prediction model of AKI in sepsis patients was constructed and the decision curve analysis(DCA)was performed.Results Serum NRF2(2.74±0.54 vs.1.20±0.21)and HO-1(6.69±1.27 vs.3.19±0.52)were higher in the study group than in the control group(t=30.537 and 29.302,P<0.001).The incidence of AKI was 45.45%(60/132)in the 132 sepsis patients within one week after admission.With the increase of serum NRF2 and HO-1,a trend towards the decreased of AKI incidence happened(χ^(2)=35.636 and 28.514,P<0.001).Multivariate logistic regression showed that NRF2(OR=0.104,95%CI:0.023~0.471)and HO-1(OR=0.341,95%CI:0.168~0.691)were the independent protective factors for AKI in sepsis patients,while SOFA score(OR=1.493,95%CI:1.128~1.976),procalcitonin(OR=1.277,95%CI:1.070~1.523)and white blood cell count(OR=3.030,95%CI:1.550~5.921)were the independent risk factors for AKI in sepsis patients(P<0.05).The nomogram prediction model showed that serum NRF2 and HO-1 had higher predictive values for AKI in sepsis patients,and the consistency indexes were 0.769 and 0.751,respectively.DCA showed that in the threshold range of 0.20~0.78,the net benefit rate of combined assessment of AKI in sepsis patients was better than that of NRF2 or HO-1 alone.Conclusion Serum NRF2 and HO-1 levels elevate in sepsis patients,and the combined assay of both levels is helpful to predict the risk of AKI.