脓毒症急性肾损伤患者血清尿调节素 水平及临床意义

Level of serum uromodulin in patients with sepsis associated acute kidney injury and its clinical significance

摘要:

目的 探讨脓毒症急性肾损伤（AKI）患者血清尿调节素水平及临床意义。方法 选取2017 年 1 月—2017 年12 月浙江医院收治的脓毒症AKI 患者80 例作为AKI 组，同期脓毒症无AKI 患者80 例作为非 AKI 组。收集两组临床资料和生化指标，采用酶联免疫吸附试验测定血清尿调节素水平。结果 AKI 组急性 生理与慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、血清肌酐（Scr）、尿素氮（BUN）、胱抑素C（CysC）高 于非AKI 组（P <0.05），而肾小球滤过率（eGFR）、尿调节素低于非AKI 组（P <0.05）。Ⅱ、Ⅲ期AKI 患者 血清尿调节素水平低于Ⅰ期（P <0.05），且Ⅲ期AKI 患者血清尿调节素水平低于Ⅱ期（P <0.05）。死亡组血 清尿调节素水平低于存活组（P <0.05）。AKI 患者血清尿调节素水平与Scr、BUN、CysC 呈负相关（r =-0.612、 -0.426 和-0.523，均P =0.000），而与eGFR 呈正相关（r =0.631，P =0.000）。血清尿调节素诊断脓毒症AKI 的敏感性为61.00%（95% CI ：0.546，0.675），特异性为64.00%（95% CI ：0.584，0.693）；BUN 诊断脓毒症AKI 的敏感性为60.00%（95% CI ：0.542，0.637），特异性为69.00（95% CI ：0.641，0.732）；Scr 诊断脓毒症AKI 的 敏感性为85.00%（95% CI ：0.826，0.874），特异性为83.00%（95% CI ：0.802，0.861）。结论 脓毒症AKI 患者 血清尿调节素水平降低，其水平在脓毒症AKI 严重程度和预后评估中具有一定价值，在脓毒症AKI 诊断中也 具有一定价值。

Abstract:

Objective To investigate the serum uromodulin level and its clinical significance in patients with sepsis associated acute kidney injury (AKI). Methods Totally 80 patients with sepsis associated AKI from January 2017 to December 2017 in Zhejiang Hospital were selected as the AKI group, and 80 septic patients with AKI-free were selected as the non-AKI group during the same period. Clinical data and biochemical indicators were collected. Enzyme-linked immunosorbent assay was used to determine serum uromodulin level. Results The APACHE Ⅱ score, creatinine, urea nitrogen and cystatin C (CysC) in the AKI group were higher than those in the non-AKI group (P < 0.05), and the glomerular filtration rate (eGFR) and uromodulin were lower than those in the non-AKI group (P < 0.05 ). Serum uromodulin levels in patients with AKI stage II and III were lower than those in stage I (P < 0.05). Serum uromodulin levels in patients with AKI stage III were lower than those in stage II (P < 0.05). The level of serum uromodulin in the death group was lower than that in the survival group (P < 0.05). AKI patients' serum uromodulin level was negatively correlated with creatinine level (r = -0.612), urea nitrogen level (r = -0.426)and CysC level (r = -0.523), and was positively correlated with eGFR water (r = 0.631) (all P < 0.05). The sensitivity of serum uromodulin to diagnose AKI in sepsis was 61.00% (95% CI: 0.546, 0.675) and the specificity was 64.00% (95% CI: 0.584, 0.693); the sensitivity of urea nitrogen for the diagnosis of sepsis AKI was 60.00% (95% CI: 0.542, 0.637) and the specificity was 69.00% (95% CI: 0.641, 0.732); the sensitivity of creatinine to diagnose AKI in sepsis was 85.00% (95% CI: 0.826, 0.874) and the specificity was 83.00% (95% CI: 0.802, 0.861). Conclusion The level of serum uromodulin in patients with sepsis AKI is reduced, and its level has a certain value in the evaluation of the severity and prognosis of sepsis associated AKI, and also has a certain value in the diagnosis of sepsis associated AKI.