脓毒症相关急性肾损伤患者血清Galectin-1、Galectin-3水平变化及其与院内死亡的关系

Changes in serum Galectin-1 and Galectin-3 levels in patients with sepsis related acute kidney injury and their relationship with in-hospital mortality

目的探讨不同病情严重程度脓毒症相关急性肾损伤(SA-AKI)患者血清半乳糖凝集素(Gal)-1、Gal-3的变化及其与院内死亡的关系。方法纳入2020年1月—2023年1月山西省临汾市中心医院重症医学科收治的脓毒症患者243例,其中SA-AKI患者123例作为SA-AKI组,单纯脓毒症患者120例为单纯脓毒症组。SA-AKI组患者根据急性肾损伤(AKI)分期分为1期亚组(48例)、2期亚组(43例)、3期亚组(32例),并根据患者的院内结局分为死亡亚组和存活亚组。采用酶联免疫吸附法检测血清Gal-1、Gal-3水平。通过多因素Logistic回归分析SA-AKI患者院内死亡的影响因素。受试者工作特征(ROC)曲线分析血清Gal-1、Gal-3水平对SA-AKI患者院内死亡风险的预测价值。结果与单纯脓毒症组比较,SA-AKI组血清Gal-1、Gal-3水平升高(t/P=34.417/<0.001、15.207/<0.001)。1期亚组、2期亚组、3期亚组血清Gal-1、Gal-3水平依次升高(F/P=262.989/<0.001、688.207/<0.001)。单因素分析显示,年龄、AKI分期、使用血管活性药物、机械通气、急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分、血乳酸、Gal-1、Gal-3为SA-AKI患者院内死亡的影响因素(χ^(2)/t=3.514、43.619、7.041、8.483、4.563、4.081、10.282、6.335,P<0.05或0.01)。多因素Logistic回归分析显示,年龄≥60岁、AKI分期2~3期、机械通气和APACHEⅡ评分、血乳酸、Gal-1、Gal-3水平升高为SA-AKI患者院内死亡的独立危险因素[OR(95%CI)=1.683(1.145~2.476)、2.710(1.107~6.633)、3.670(1.398~9.631)、1.548(1.070~2.240)、1.532(1.123~2.093)、1.438(1.042~1.984)、1.040(1.016~1.065)、1.192(1.071~1.327),P<0.05或0.01]。ROC曲线分析显示,血清Gal-1、Gal-3水平单独和联合预测SA-AKI患者院内死亡的曲线下面积(AUC)分别为0.720(0.454~0.960)、0.771(0.558~0.971)、0.830(0.686~0.967),二者联合的预测价值大于各指标单独预测(Z=2.652、2.968,P=0.008、0.003)。结论血清Gal-1、Gal-3水平升高与SA-AKI患者病情程度加重和院内死亡密切相关,联合检测血清Gal-1、Gal-3水平对SA-AKI患者院内死亡的预测价值较高。

Objective To investigate the changes in serum Gal-1 and Gal-3 levels in patients with sepsis associated acute kidney injury(SA-AKI)of different severity levels and their relationship with in-hospital mortality.Methods Two hundred and forty-three patients with sepsis admitted to the Intensive Care Department of Linfen Central Hospital in Shanxi Province from January 2020 to January 2023 were included,including 123 SA-AKI patients as the SA-AKI group and 120 patients with simple sepsis as the simple sepsis group.Patients in the SA-AKI group were divided into stage 1 subgroup(48 cases),stage 2 subgroup(43 cases),and stage 3 subgroup(32 cases)based on acute kidney injury(AKI)staging,and were divided into death subgroup and survival subgroup according to their in-hospital outcomes.Enzyme linked immunosorbent assay was used to detect serum Gal-1 and Gal-3 levels.Analyze the influencing factors of in-hospital mortality in SA-AKI patients through multiple logistic regression analysis.The predictive value of receiver operating characteristic(ROC)curve analysis of serum Gal-1 and Gal-3 levels on the risk of in-hospital mortality in SA-AKI patients.Results Compared with the simple sepsis group,the serum Gal-1 and Gal-3 levels in the SA-AKI group increased(t/P=34.417/<0.001,15.207/<0.001).The serum Gal-1 and Gal-3 levels in the 1st,2nd,and 3rd subgroups increased sequentially(F/P=302.934/<0.001,51.068/<0.001).Univariate analysis showed that age,AKI stage,use of vasoactive drugs,mechanical ventilation,acute physiological and chronic health assessment II(APACHE II)scores,blood lactate,Gal-1,and Gal-3 were the influencing factors for in-hospital mortality in SA-AKI patients(χ^(2)/t=3.514,43.619,7.041,8.483,4.563,4.081,10.282,6.335,P<0.05 or 0.01).Multivariate logistic regression analysis showed that age≥60 years,AKI stage 2-3,mechanical ventilation and APACHE II score,elevated blood lactate,Gal-1,and Gal-3 levels were independent risk factors for in-hospital mortality in SA-AKI patients[OR(95%CI)=1.683(1.145-2.476),2.710(1.107-6.633),3.670(1.398-9.631),1.548(1.070-2.240),1.532(1.123-2.093),1.438(1.042-1.984)1.040(1.016-1.065),1.192(1.071-1.327),P<0.05 or 0.01].ROC curve analysis showed that the area under the curve(AUC)for predicting in-hospital mortality in SA-AKI patients was 0.720(0.454-0.960),0.771(0.558-0.971),and 0.830(0.686-0.967)for serum Gal-1 and Gal-3 levels alone and in combination,respectively.The combined predictive value of the two indicators was greater than that of each indicator alone(Z=2.652,2.968,P=0.008,0.003).Conclusion The elevated levels of serum Gal-1 and Gal-3 are closely related to the worsening of the condition and in-hospital mortality in SA-AKI patients.The combined detection of serum Gal-1 and Gal-3 levels has a high predictive value for in-hospital mortality in SA-AKI patients.