脓毒症合并急性肾损伤患者TLR4信号通路相关因子的表达及其预后因素分析

Expression of TLR4 signaling pathway related factors and prognosis in sepsis complicated with acute kidney injury

摘要:

目的 探讨影响脓毒症合并急性肾损伤（AKI）预后的危险因素。方法 回顾性分析萍乡矿业集团有限责任公司总医院2020年7月—2021年7月收治的脓毒症合并AKI患者90例的临床资料，根据患者自入院治疗日起1月内的存活情况分为存活组（40例）和死亡组（50例）。收集两组患者的基本资料［性别、年龄、体质量指数（BMI）、糖尿病史、高血压史、心血管病史、使用血制品、使用激素、机械通气、多器官衰竭］和实验室指标［Toll样受体4（TLR4）、高迁移率族蛋白B1（HMGB1）、血肌酐（Scr）、平均动脉压（MAP）］。多因素Logistic逐步回归分析影响脓毒症合并AKI患者预后不良的危险因素。绘制受试者工作特征（ROC）曲线分析TLR4、HMGB1、Scr预测脓毒症合并AKI患者预后不良的价值。结果 死亡组机械通气、多器官衰竭占比均高于存活组（P <0.05），TLR4、HMGB1、Scr水平均高于存活组（P <0.05）。多因素Logistic逐步回归分析结果显示，机械通气［O^R=4.219（95% CI：2.851，6.313）］、多器官衰竭［O^R=3.110（95% CI：2.181，4.479）］、TLR4［O^R=2.122（95% CI：1.846，2.562）］、HMGB1［O^R=2.321（95% CI：1.918，2.594）］、Scr［O^R=2.703（95% CI：1.287，5.502）］是脓毒症合并AKI患者预后不良的危险因素（P <0.05）。TLR4、HMGB1、Scr预测脓毒症合并AKI患者预后不良的敏感性分别为92.0%（95% CI：0.816，0.933）、92.0%（95% CI：0.764，0.973）、84.0%（95% CI：0.810，0.920），特异性分别为85.0%（95% CI：0.774，0.935）、70.0%（95% CI：0.624，0.825）、85.0%（95% CI：0.811，0.935），AUC分别为0.926（95% CI：0.811，0.976）、0.912（95% CI：0.802，0.796）、0.917（95% CI：0.753，0.962）。结论 机械通气、多器官衰竭、TLR4、HMGB1、Scr是脓毒症合并AKI患者预后不良的危险因素。

Abstract:

Objective To investigate the risk factors influencing the prognosis of patients with sepsis complicated with acute kidney injury (AKI).Methods The clinical data of 90 patients with sepsis complicated with AKI admitted to our hospital from July 2020 to July 2021 were retrospectively analyzed, and the patients were divided into survival group (40 cases) and death group (50 cases) according to the prognosis. Two groups of patients on the basis of information collection [age, sex, body mass index (BMI), diabetes history, history of hypertension, cardiovascular disease, use of blood products, using hormones, mechanical ventilation, multiple organ failure] and laboratory index [toll-like receptor 4 (TLR4), high mobility group B1 (HMGB1) protein, serum creatinine (Scr), flat Mean arterial pressure]. ROC curve was used to analyze the value of TLR4, HMGB1, Scr, and the number of failing organs in predicting poor prognosis of patients with sepsis complicated with AKI. Unconditional Logistic stepwise regression analysis was used to determine the risk factors for poor prognosis in patients with sepsis complicated with AKI.Results The proportion of mechanical ventilation and multiple organ failure in the death group was significantly higher than that in the survival group, and the levels of TLR4, HMGB1, and Scr were significantly higher than those in the survival group, with statistical significance (P < 0.05). According to ROC analysis, TLR4 ≥ 4.709 ng/mL, HMGB1 ≥ 11.820 pg/mL, and Scr ≥ 270.993 μmol/L were the best cut-off values for predicting poor prognosis in patients with sepsis complicated with AKI (P < 0.05). Logistic stepwise regression analysis showed that mechanical ventilation, multiple organ failure, TLR4, HMGB1, and Scr were risk factors for poor prognosis in patients with sepsis complicated with AKI (P < 0.05).Conclusion Mechanical ventilation, multiple organ failure, TLR4, HMGB1, and Scr are the risk factors for poor prognosis in patients with sepsis complicated with AKI.