抗凝血酶Ⅲ联合降钙素原在SA-AKI中的预测价值

Predictive Value of Combining the Level of Antithrombin Ⅲ and Procalcitonin for SA-AKI

目的 探讨抗凝血酶Ⅲ(antithrombinⅢ, AT-Ⅲ)联合降钙素原(procalCI tonin, PCT)对脓毒症相关急性肾损伤(sepsis assoCI ated acute kidney injury, SA-AKI)的预测价值。方法 共纳入符合入组标准的脓毒症的患者96例,将所有患者分为AKI组(n=42)和非AKI组(n=54),并对比两组患者的数据;绘制ROC曲线以评估AT-Ⅲ水平、PCT水平以及联合对SA-AKI的预测效果,同时运用多因素Logistic回归分析来研究SA-AKI的影响因素。结果 AKI组PCT、CRP、纤维蛋白原、SOFA评分、APACHEⅡ评分、血管活性药物使用比例、血液净化应用比例高于非AKI组(P<0.05),AT-Ⅲ、血小板计数低于非AKI组(P<0.05)。两者联合预测脓毒症患者发生SA-AKI的ROC曲线下面积为0.876(95%CI:0.793~0.935,P<0.01),敏感度为78.6%,特异性为88.9%。多因素Logistic回归分析结果显示,AT-Ⅲ(OR=0.907, 95%CI:0.860~0.956)、PCT(OR=1.037, 95%CI:1.002~1.074)是SA-AKI独立的影响因素。结论 AT-Ⅲ联合PCT可以用于预测SA-AKI的发生,具有良好的预测效能。

Objective To investigate the predictive effect of antithrombinⅢ(AT-Ⅲ)combined with procalcitonin(PCT)on sepsis-associated acute kidney injury(SA-AKI).Methods A total of 96 patients with sepsis who met the inclusion criteria were included,all patients were divided into the AKI group(n=42)and non-AKI group(n=54),and the data between the two groups were compared.We used the receiver operating characteristic(ROC)curves to evaluate the predictive effect of antithrombinⅢlevel,procalCI tonin level,and combination on SA-AKI.Multivariate Logistic regression analysis was used to study the influencing factors of SA-AKI.Results The proportion of PCT,CRP,fibrinogen,SOFA score,APACHEⅡscore,vasoactive drug use,and blood purification application in the AKI group was higher than that in the non-AKI group(P<0.05),as well as the AT-Ⅲ,and platelet count were lower than those in the non-AKI group(P<0.05).The area under the ROC curve for predicting SA-AKI in patients with sepsis was 0.876(95%CI:0.793-0.935,P<0.01),the sensitivity was 78.6%,and the specificity was 88.9%.Multivariate Logistic regression analysis showed that AT-Ⅲ(OR=0.907,95%CI:0.860-0.956)and PCT(OR=1.037,95%CI:1.002-1.074)were independent influencing factors for SA-AKI.Conclusion AT-Ⅲcombined with PCT could be used to predict SA-AKI and has good predictive efficacy.