[1]谢琼燕,许环清,叶 文,等.生物标志物预测脓毒症引发急性肾损伤临床研究[J].陕西医学杂志,2023,52(7):880-884.[doi:DOI:10.3969/j.issn.1000-7377.2023.07.024]
　XIE Qiongyan,XU Huanqing,YE Wen,et al.Clinical study of using biomarkers to predict acute kidney injury induced by sepsis[J].,2023,52(7):880-884.[doi:DOI:10.3969/j.issn.1000-7377.2023.07.024]
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生物标志物预测脓毒症引发急性肾损伤临床研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年7期
页码:
880-884
栏目:
临床研究
出版日期:
2023-07-05

文章信息/Info

Title:
Clinical study of using biomarkers to predict acute kidney injury induced by sepsis
作者:
谢琼燕1; 许环清2; 叶 文1; 吴 泽1
(1.中南大学湘雅医学院附属海口医院急诊科,海南 海口 570100; 2.海南省人民医院,海南 海口 570000)
Author(s):
XIE Qiongyan; XU Huanqing; YE Wen; WU Ze
(Department of Emergency Medicine,Haikou people's Hospital,Central South University Xiangya School of Medicine,Haikou 570100,China)
关键词:
急性肾损伤;  生物标志物;  脓毒症;  胰岛素样生长因子结合蛋白7;  金属蛋白酶组织抑制剂2
Keywords:
Acute kidney injury;  Biomarkers;  Sepsis;  Insulin-like growth factor binding protein 7;  Tissue inhibitor of metalloproteinases-2
分类号:
R 692
DOI:
DOI:10.3969/j.issn.1000-7377.2023.07.024
文献标志码:
A
摘要:
目的:探讨使用生物标志物预测脓毒症引发急性肾损伤(AKI)的可行性。方法: 683例急性肾损伤患者分为三组,临床诊断为脓毒症的患者(n=213)、感染但无脓毒症的患者(n=120)以及入组时未感染的患者(n=350)。AKI状态在入组后的前3 d内确定,病死率评估自入组后长达9个月。使用逻辑回归模型比较了每个感染组有或没有AKI的患者之间的30 d病死率。比较3个感染组之间或组对之间的一般资料,采用Kruskal-Wallis检验和Cox回归法,对所有患者在9个月内死亡情况进行了分析。结果:综合所有组,脓毒症和 2～3 期 AKI 患者的 30 d病死率为27.7%,在感染且没有脓毒症临床诊断的患者中,2～3 期 AKI 患者的 30 d病死率为34.2%,而没有 2～3 期 AKI 的患者为11.7%。然而,这种差异在无脓毒症感染组中最大,感染或不伴有脓毒症的患者2～3期 AKI(26.8%:27.5%)和 30 d病死率(19.2%:18.3%)的发生率相似。与生物标志物阴性的AKI相比,金属蛋白酶组织抑制剂2(TIMP-2)×胰岛素样生长因子结合蛋白7(IGFBP7)>1(ng/ml)2 /1000的1期患者和(TIMP-2)×(IGFBP7)>2(ng/ml)2 /1000的2～3期患者在各自阶段的生存率都比较低。结论:使用尿液(TIMP-2)×(IGFBP7)检测可以识别感染患者的急性肾损伤,可能有助于早期识别脓毒症引发的急性肾损伤。
Abstract:
Objective:To explore the feasibility of using biomarkers to predict acute kidney injury(AKI)induced by sepsis.Methods:A total of 683 patients were divided into three groups:patients with a clinical diagnosis of sepsis(213 cases),patients with the infection without sepsis(120 cases),and patients without infection at enrollment(350 cases).AKI status was determined within the first 3 days after enrollment,and mortality was assessed up to 9 months after enrollment.Thirty-day mortality was compared between patients with and without AKI in each infection group by using Logistic regression models.The general data among the three infection groups or pairs of groups were compared,and the clinical scientific research intelligent decision-support system of Beijing Dashu Huikang Medical Technology Co.,Ltd.based on Kruskal-Wallis test and Cox regression method was used to analyze the death of all patients within 9 months.Results:For all groups,the 30-day mortality rate was 27.7% for patients with sepsis and stage 2-3 AKI and 34.2% for patients with stage 2-3 AKI among patients with infection and no clinical diagnosis of sepsis,and 11.7% for patients without stage 2-3 AKI.However,this difference was most significant in the group without sepsis infection,with a similar incidence of stage 2-3 AKI(26.8% vs.27.5%)and 30-day mortality(19.2% vs.18.3%)in patients infected or without sepsis.Stage 1 patients with(TIMP-2)×(IGFBP7)>1(ng/ml) 2 /1000 and stage 2-3 patients with(TIMP-2)×(IGFBP7)>2(ng/ml) 2 /1000 had lower survival rates at their respective stages compared to AKI with negative biomarkers.Conclusion:The use of the urine(TIMP-2)×(IGFBP7)test can identify acute kidney injury in infected patients and may help identify sepsis-induced acute kidney injury early.

参考文献/References:

[1] 王兴程,张向宁,侯崇智,等.右美托咪定在脓毒症治疗中的作用及机制研究进展[J].陕西医学杂志,2022,51(3):382-385.
[2] 王 婷,韦小碗,杨 亮,等.脓毒症患者血清PCT、CRP、IL-6和IL-10水平检测及临床意义[J].陕西医学杂志,2020,49(11):1510-1514.
[3] Churpek MM,Zadravecz FJ,Winslow C,et al.Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients[J].American Journal of Respiratory and Critical Care Medicine,2015,192(8):958-964.
[4] 张 星,高 明,赵 武,等.微小RNA-21对急性肾损伤模型大鼠线粒体氧化磷酸化的影响及机制研究[J].陕西医学杂志,2022,51(3):274-279.
[5] Introcaso G,Nafi M,Bonomi A,et al.Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury after cardiac surgery[J].Biochemia Medica,2018,28(3):399-405.
[6] Albeladi FI,Algethamy HM.Urinary neutrophil gelatinase-associated lipocalin as a predictor of acute kidney injury,severe kidney injury,and the need for renal replacement therapy in the intensive care unit[J].Nephron Extra,2017,7(2):62-77.
[7] Ortuno-Anderiz F,Cabello-Clotet N,Vidart-Simón N,et al.Cistatina C como marcador precoz de lesión renal agudaenel shock séptico[J].Revista Clínica Espanola,2015,215(2):83-90.
[8] Emlet DR,Pastor-Soler N,Marciszyn A,et al.Insulin-like growth factor binding protein 7 and tissue inhibitor of metalloproteinases-2:Differential expression and secretion in human kidney tubule cells[J].American Journal of Physiology-Renal Physiology,2017,312(2):f284-f296.
[9] Zarbock A,Schmidt C,Van-Aken H.Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac surgery:A randomized clinical trial[J].Journal of Vascular Surgery,2016,63(2):552.
[10] Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:International guidelines for management of sepsis and septic shock:2016[J].Intensive Care Medicine,2017,43(3):304-377.
[11] Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clinical Practice,2012,120(4):c179-c184.
[12] Lambden S,Laterre PF,Levy MM,et al.The SOFA score-development,utility and challenges of accurate assessment in clinical trials[J].Critical Care,2019,23(1):1-9.
[13] 周 丽.ICU 脓毒症急性肾损伤的危险因素及预后影响的回顾性分析 [D].昆明:昆明医科大学,2018.
[14] Ma J,Deng Y,Lao H,et al.A nomogram incorporating functional and tubular damage biomarkers to predict the risk of acute kidney injury for septic patients[J].BMC Nephrology,2021,22(1):1-13.
[15] Investigators P.A randomized trial of protocol-based care for early septic shock[J].New England Journal of Medicine,2014,370(18):1683-1693.
[16] Kellum JA,Chawla LS,Keener C,et al.The effects of alternative resuscitation strategies on acute kidney injury in patients with septic shock[J].American Journal of Respiratory and Critical Care Medicine,2016,193(3):281-287.
[17] Song JU,Sin CK,Park HK,et al.Performance of the quick Sequential(sepsis-related)organ failure assessment score as a prognostic tool in infected patients outside the intensive care unit:A systematic review and meta-analysis[J].Critical Care,2018,22(1):1-13.
[18] Godi I,De Rosa S,Martino F,et al.Urinary [TIMP-2]×[IGFBP7]and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients[J].Annals of Intensive Care,2020,10(1):1-9.
[19] 罗仁杰.脓毒症相关急性肾损伤患者的危险因素及预后分析 [D].重庆: 重庆医科大学,2021.
[20] Murugan R,Karajala-Subramanyam V,Lee M,et al.Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival[J].Kidney International,2010,77(6):527-535.
[21] Joannidis M,Forni LG,Haase M,et al.Use of cell cycle arrest biomarkers in conjunction with classical markers of acute kidney injury[J].Critical Care Medicine,2019,47(10):e820.

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备注/Memo

备注/Memo:
基金项目:湖南省自然科学基金资助项目(201922518)
更新日期/Last Update: 2023-07-05