血清尿调节素, 肝素结合蛋白, Klotho 蛋白联合 APACHEⅡ评分 对脓毒症并发急性肾损伤患者 28 天预后的评估价值.

Objective: To investigate the value of serum uromodulin (UMOD), heparin-binding protein (HBP), Klotho protein combined with Acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score in predicting the 28-day prognosis in patients with sepsis complicated with acute kidney injury (AKI) . Methods: 120 patients with sepsis complicated with AKI who were diagnosed and treated in our hospital from January 2018 to January 2020 were selected as the research object. According to the survival within 28 days, they were divided into survival group (86 cases) and death group (34 cases) . Enzyme linked immunosorbent assay was used to detect the expression levels of serum UMOD, HBP and Klotho proteins in each group. The expression of serum UMOD, HBP, Klotho protein and APACHE Ⅱ score difference in patients with AKI at different stages were compared. Multivariate Logistic regression analysis was used to analyze the risk factors affecting the 28 day prognosis of patients with sepsis complicated with AKI. The receiver operating characteristic (ROC) curve was used to analyze the value of serum UMOD, HBP, Klotho protein and APACHE Ⅱ score alone and in combination in predicting the 28 day prognosis of patients with sepsis complicated with AKI. Results: Compared with the survival group, the serum UMOD and Klotho in the death group were lower, and the procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), HBP and APACHE Ⅱ scores were higher (all P<0.05) . There were significant differences in the serum UMOD, HBP, Klotho and APACHE Ⅱ scores in patients with different AKI stages (all P<0.05) . Multivariate Logistic regression analysis showed that UMOD <62.43 mg/mL and HBP > 30.14 μg/L, Klotho ≤ 180.37 ng/L and APACHE Ⅱ score > 16.00 scores were the risk factors affecting the prognosis of 28 day death. The area under the curve of the combined prediction of serum UMOD, HBP, Klotho and APACHE Ⅱ score for 28 day death in patients with sepsis complicated with AKI was 0.897 (0.842 ～ 0.939), which was significantly higher than that of the single detection of serum UMOD [0.724 (0.674 ～ 0.765) ], HBP [0.666 (0.622 ～ 0.710) ], Klotho [0.767 (0.731 ～ 0.804) ] and APACHE Ⅱscore [0.840 (0.802 ～ 0.878) ]. Conclusions: Serum UMOD and Klotho decrease, HBP level increases and APACHE Ⅱ score is higher in patients with sepsis complicated with AKI, which are related to the severity of sepsis complicated with AKI. The combination of the four can help to predict 28 days death of sepsis complicated with AKI. [ABSTRACT FROM AUTHOR]

目的:探讨血清尿调节素 (UMOD) 、肝素结合蛋白 (HBP) 、Klotho蛋白联合急性生理和慢性健康状况评估系统Ⅱ (APACHE Ⅱ) 评分预测脓毒症并发急性肾损伤 (AKI) 患者28天预后的价值。方法:选取2018年1月至2020年1月期间我院诊治的脓毒症并发AKI患者120例作为研究对象,根据28天以内的生存情况分为存活组 (86例) 和死亡组 (34例) 。采用酶联免疫吸附实验检测各组血清 UMOD、HBP、Klotho蛋白表达水平。比较不同分期的AKI患者血清UMOD、HBP、Klotho蛋白表达及APACHE Ⅱ评分差异。多因素Logistic回归分析影响脓毒症并发AKI患者28天预后的危险因素。应用受试者工作特征 (ROC) 曲线分析血清UMOD、HBP、Klotho蛋白及APACHE Ⅱ评分单独及联合预测脓毒症并发AKI患者28天预后的价值。结果:相比于存活组,死亡组患者血清UMOD、Klotho较低,降钙素原 (PCT) 、超敏C反应蛋白 (hs-CRP) 、HBP、APACHE Ⅱ评分较高 (P均＜0.05) 。不同AKI分期患者血清UMOD、HBP、Klotho及APACHE Ⅱ评分差异具有统计学意义 (P均＜0.05) 。多因素Logistic回归分析显示UMOD＜62.43 mg/mL、HBP＞30.14μg/L、Klotho≤180.37 ng/L、APACHE Ⅱ评分＞16.00分是影响患者28天死亡预后的危险因素。血清UMOD、HBP、Klotho、APACHE Ⅱ评分四者联合预测脓毒症并发AKI患者28天死亡的曲线下面积为0.897 (0.842～0.939),明显高于血清UMOD [0.724 (0.674～0.765) ]、HBP [0.666 (0.622～0.710) ]、Klotho [0.767 (0.731～0.804) ]、APACHE Ⅱ评分[0.840 (0.802～0.878) ]单一检测。结论:脓毒症并发AKI患者血清UMOD、Klotho降低,HBP水平升高且APACHE Ⅱ评分较高,与脓毒症并发AKI患者的病情严重程度有关,四者联合能辅助预测脓毒症并发AKI患者 28 天死亡. [ABSTRACT FROM AUTHOR]