血清Cys-c与NLRP3炎性小体及IL-18的水平对脓毒症AKI患者早期的预测价值

The early predictive value of serum Cys-c,NLRP3 inflammasome and IL-18 levels in septic AKI patients

目的探究血清胱抑素C(Cys-c)与核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体及白细胞介素18(IL-18)的血清水平对脓毒症急性肾损伤(AKI)患者早期的预测价值。方法选择42例脓毒症及61例脓毒症AKI作为研究对象,依据Sepsis 3.0及AKI的诊断标准将患者分为脓毒症组及脓毒症AKI组,依次收集2组患者年龄、序贯器官衰竭评估(SOFA)评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)、入住ICU时间、机械通气时间、总住院天数等基本资料,检测和比较2组患者血清中Cys-c、NLRP3炎性小体及IL-18的水平,采用logistic回归探讨脓毒症患者发生AKI的影响因素。用受试者工作特征(ROC)曲线明确血清Cys-c、NLRP3炎性小体及IL-18水平对脓毒症患者发生AKI的预测能力。依据28 d存活与否,将脓毒症AKI患者分为存活组与死亡组,比较2组患者间Cys-c、NLRP3炎性小体及IL-18的水平。结果单因素分析提示脓毒症AKI组患者的血清Cys-c、NLRP3炎性小体及IL-18的水平明显高于脓毒症组(P<0.05),多因素logistic回归分析显示血清Cys-c及NLRP3炎性小体的水平是导致脓毒症患者发生AKI的有害指标。ROC曲线分析,血清Cys-c、NLRP3炎性小体及IL-18的AUC值分别为0.805(95%CI:0.722~0.889)、0.850(95%CI:0.776~0.924)、0.772(95%CI:0.678~0.866),血清Cys-c联合IL-18及NLRP3炎性小体预测脓毒症患者发生AKI的AUC值分别是0.861,0.810,证实血清Cys-c与IL-18的联合预测水平优于单一指标。在存活与死亡组中,死亡组的IL-18水平明显高于存活组(P<0.05)。结论血清Cys-c、NLRP3炎性小体及IL-18的水平对脓毒症AKI患者早期预测具有一定的价值。

ObjectiveTo investigate the early predictive value of Cys-c and NLRP3 inflammasome and IL-18 levels in patients with septic AKI.Methods 42 cases of sepsis and 61 cases of sepsis AKI were selected as the study objects.The patients were divided into sepsis group and sepsis AKI group according to Sepsis3.0 and the diagnostic criteria of AKI.Basic data such as age,SOFA score,acute physiology and chronic health status scoreⅡ(APACHEII score),ICU stay time,mechanical ventilation time,total hospitalization days were collected in order to detect and compare the levels of serum Cys-c,NLRP3 and IL-18 of patients in two groups.logistic regression was used to investigate the influencing factors of AKI in patients with sepsis.The predictive ability of serum Cys-c,NLRP3 and IL-18 for AKI in patients with sepsis was determined by receiver operating characteristic(ROC)curve.According to 28-day survival,patients with sepsis AKI were divided into survival group and death group,and the levels of Cys-c,NLRP3 and IL-18 were compared between the two groups.Results Univariate analysis suggested that the levels of serum Cys-c,NLRP3 and IL-18 in patients with sepsis AKI group were significantly higher than those in patients with sepsis group(P<0.05).Multivariate logistic regression analysis showed that the levels of serum Cys-c and NLRP3 were independent risk factors for AKI in sepsis Patients.In ROC curve analysis,the AUC values of serum Cys-c,NLRP3 and IL-18 were 0.805(95%CI:0.722~0.889),0.850(95%CI:0.776~0.924),and 0.772(95%CI:0.678~0.866),respectively.Serum Cys-c combined with IL-18 predicted the AUC value of 0.861 in patients with sepsis,and serum Cys-c combined with NLRP3 predicted the AUC value of 0.810 in patients with sepsis.The combination of serum Cys-c and IL-18 was superior to a single index.According to 28-day survival,patients with septic AKI were divided into survival group and death group.Compared with survival group,IL-18 level in death group was significantly increased(P<0.05).Conclusion Serum levels of Cys-c,NLRP3 and IL-18 have certain predictive value in early stage of AKI patients with sepsis.