α1 抗胰蛋白酶与脓毒症患者发生急性 肾损伤的关系及其预测价值

Correlation of both serum and urine α1-antitrypsin with acute kidney injury and their early predictive values in sepsis patients

摘要:

目的 探讨α1 抗胰蛋白酶（α1-AT）与脓毒症患者急性肾损伤（AKI）发生的关系及其预测 价值。方法 选取2017 年9 月—2019 年10 月在宁波大学医学院附属医院重症医学科住院的脓毒症患者90 例。 28 例AKI 患者作为AKI 组，其余62 例患者未合并AKI 作为非AKI 组。连续监测患者7 d 血清和尿α1- AT，并绘制受试者工作特征（ROC）曲线分析AKI 确诊前48 和24 h 及当日对脓毒症患者发生AKI 的预 警或诊断价值。结果 ①与非AKI 患者入组当日数据比较，AKI 组患者AKI 确诊前48 和24 h 及确诊当 日血清α1-AT 含量降低（P <0.05），而尿α1-AT 含量升高（P <0.05）。②经ROC 曲线分析，AKI 确诊 前48 和24 h 尿α1-AT 对AKI 的预警效能高于血清α1-AT（P <0.05）。③多因素非条件一般Logistic 回 归分析结果显示，尿α1-AT 是AKI 发生的独立影响因素[Ol ^ R=1.813（95% CI ：1.230，2.974），P =0.001]。 结论 脓毒症合并AKI 患者血清α1-AT 含量升高，而尿α1-AT 含量降低，对AKI 发生具有早期预警和诊 断效能，且尿α1-AT 是AKI 发生的独立影响因素。

Abstract:

Objective To analyzed the correlation of both serum and urine α1-antitrypsin (α1-AT) with acute kidney injury (AKI) and their early predictive values in sepsis patients. Methods A total of 90 sepsis patients in our hospital were selected from september 2017 to October 2019 and divided into AKI group with 28 AKI patients and non-AKI group with 62 patients without AKI. Serum and urine α1-AT levels were continuously determined for 7days. The predict or diagnosis of serum and urine α1-AT levels at the day when patients had been diagnosed as AKI or 48h and 24 h before that were analyzed by receiver operating characteristic (ROC) curve. Results ① The serum α1-AT levels in AKI group at the day when patients had been diagnosed as AKI or 48 h and 24 h before that were all lower than those levels in non-AKI group (P < 0.05); while the urine α1-AT levels in AKI group were all higher than those levels in non-AKI group (P < 0.05). ② The predictive value of urine α1-AT 48 h and 24 h before AKI diagnosis were higher than serum α1-AT (P < 0.05). ③ Multivariate Logistic regression analysis results showed that urine α1-AT was the independent factor of AKI [Ol ^ R = 1.81 (95% CI: 1.23, 2.97), P = 0.001). Conclusion Serum α1-AT level in sepsis-AKI patients increased, but urine α1-AT level declines, which may be the early predictive or diagnostic factors of AKI. And the urine α1-AT may be the independent risk factor for AKI.