血清VNN1及CCN2检测对2~4期慢性肾脏病并发急性肾损伤的预测价值

The predictive value of serum VNN1 and CCN2 detection for acute kidney injury in patients with stage 2-4 chronic kidney disease

目的分析2~4期慢性肾脏病(CKD)患者血清血管非炎性因子(VNN1)、细胞交流网络因子2(CCN2)水平及对并发急性肾损伤(AKI)的预测价值。方法选取2020年3月—2022年3月重庆医科大学附属第一医院梁平医院肾内科诊治2~4期CKD患者102例为CKD组,根据是否并发AKI,分为AKI亚组28例和非AKI亚组74例,以同期体检的健康者60例为健康对照组。Pearson相关分析血清VNN1、CCN2与肾疾病指标的相关性;多因素Logistic回归分析影响2~4期CKD患者并发AKI的因素;受试者工作特征曲线分析血清VNN1、CCN2及二者联合对2~4期CKD患者并发AKI的预测价值。结果CKD组患者血清VNN1、CCN2水平高于健康对照组(t=34.043,16.383,P均<0.001)。AKI亚组血肌酐、血尿酸、血尿素氮、24 h尿蛋白定量及血清VNN1、CCN2水平均高于非AKI亚组(t/P=4.842/<0.001,3.578/0.001,5.268/<0.001,3.876/<0.001,20.046/<0.001,10.791/<0.001)。2~4期CKD患者血清VNN1、CCN2与血肌酐、血尿酸、血尿素氮、24 h尿蛋白定量呈显著正相关(VNN1:r/P=0.627/<0.001,0.624/<0.001,0.521/<0.001,0.705/<0.001;CCN2:r/P=0.646/<0.001,0.610/<0.001,0.536/<0.001,0.689/<0.001)。血肌酐、血尿素氮、血尿酸、24h尿蛋白定量、血清VNN1、CCN2升高是影响2~4期CKD患者并发AKI的独立危险因素[OR(95%CI)=1.602(1.268~2.022),1.652(1.263~2.161),1.594(1.252~2.028),1.579(1.196~2.086),1.568(1.131~2.176),1.673(1.124~2.385)]。血清VNN1、CCN2及二者联合预测2~4期CKD患者并发AKI的AUC为0.814、0.822、0.890,二者联合的AUC大于单一指标检测(Z=4.675、4.513,P均<0.001)。结论2~4期CKD患者血清VNN1、CCN2升高,两者是影响2~4期CKD患者并发AKI的独立危险因素,且二者联合对2~4期CKD并发AKI具有较高的预测价值。

Objective To analyze the serum levels of vascular non inflammatory factor 1(VNN1)and cell communication network factor 2(CCN2)in patients with stage 2-4 chronic kidney disease(CKD)and their predictive value for concurrent acute kidney injury(AKI).Method One hundred and two patients with stage 2-4 CKD treated in the Department of Nephrology,Liangping Hospital,First Affiliated Hospital of Chongqing Medical University from March 2020 to March 2022 were selected as the CKD group.According to whether AKI was complicated,they were divided into 28 AKI subgroups and 74 non-AKI subgroups.60 healthy individuals who underwent physical examinations during the same period were selected as the healthy control group.Pearson correlation analysis of the correlation between serum VNN1,CCN2 and renal disease indicators.Multivariate logistic regression analysis was conducted to identify the factors that affect the incidence of AKI in stage 2-4 CKD patients;The predictive value of serum VNN1,CCN2,and their combination in predicting AKI in patients with stage 2-4 CKD by analyzing the working characteristic curve of the subjects.Results The serum levels of VNN1 and CCN2 in the CKD group were higher than those in the healthy control group(t=34.043,16.383,P<0.001).The levels of serum creatinine,blood uric acid,blood urea nitrogen,24-hour urine protein quantification,and serum VNN1 and CCN2 in the AKI subgroup were higher than those in the non AKI subgroup(t/P=4.842/<0.001,3.578/0.001,5.268/<0.001,3.876/<0.001,20.046/<0.001,10.791/<0.001).The serum VNN1 and CCN2 levels in stage 2-4 CKD patients were significantly positively correlated with blood creatinine,blood uric acid,blood urea nitrogen,and 24-hour urine protein quantification(VNN1:r/P=0.627/<0.001,0.624/<0.001,0.521/<0.001,0.705/<0.001;CCN2:r/P=0.646/<0.001,0.610/<0.001,0.536/<0.001,0.689/<0.001).Elevated levels of blood creatinine,blood urea nitrogen,blood uric acid,24-hour urine protein quantification,serum VNN1,and CCN2 are independent risk factors for AKI in stage 2-4 CKD patients[OR(95%CI)=1.602(1.268-2.022),1.652(1.263-2.161),1.594(1.252-2.028),1.579(1.196-2.086),1.568(1.131-2.176),1.673(1.124-2.385)].The AUC of serum VNN1,CCN2,and their combined prediction for AKI in stage 2-4 CKD patients were 0.814,0.822,and 0.890,respectively.The combined AUC of the two was greater than that of a single indicator test(Z=4.675,4.513,P<0.001).Conclusion Elevated serum VNN1 and CCN2 levels are independent risk factors for AKI in patients with stage 2-4 CKD,and their combination has high predictive value for AKI in stage 2-4 CKD.