β2-MG联合N/LPR对重症急性胰腺炎患者急性肾损伤的预测价值

Value of β2-MG combined with N/LPR in predicting acute kidney injury in patients with severe acute pancreatitis

摘要:

目的 探讨β₂微球蛋白（β₂-MG）、中性粒细胞/淋巴细胞和血小板比值（N/LPR）检测对重症急性胰腺炎（SAP）患者急性肾损伤（AKI）的预测价值。方法 前瞻性选取2021年1月—2024年3月延安市中医医院收治的159例SAP患者。根据患者住院期间AKI发生情况分为AKI组、非AKI组。收集患者治疗前β₂-MG、N/LPR等资料，分析AKI组、非AKI组β₂-MG、N/LPR水平及影响SAP患者并发AKI的因素，分析β₂-MG、N/LPR的交互作用对SAP患者并发AKI的影响，分析β₂-MG、N/LPR预测SAP患者并发AKI的价值。结果 两组患者性别构成、年龄、体质量指数、SAP类型构成、基础疾病、冠心病、吸烟史、饮酒史、并发腹腔间隔室综合征、并发全身炎症反应综合征、休克、甘油三酯、总胆固醇、白细胞计数、淀粉酶、血红蛋白、纤维蛋白原比较，差异均无统计学意义（P >0.05）。AKI组PACHE Ⅱ评分、血乳酸、血肌酐、尿素氮、胱抑素C、C反应蛋白、β₂-MG、N/LPR均高于非AKI组（P <0.05）。多因素逐步Logistic回归分析，结果显示：β₂-MG水平高［O^R=4.314（95% CI：1.673，11.125）］、N/LPR水平高［O^R=3.991（95% CI：1.193，13.353）］、血肌酐水平高［O^R=4.444（95% CI：1.410，14.005）］、胱抑素C水平高［O^R=8.919（95% CI：1.904，41.788）］、β₂-MG/N/LPR交互作用［O^R=5.692（95% CI：1.945，16.652）］均是影响SAP患者并发AKI的危险因素（P <0.05）。受试者工作特征曲线分析结果显示，β₂-MG、N/LPR及两者联合预测SAP患者并发AKI的敏感性分别为68.85%（95% CI：0.603，0.741）、70.73%（95% CI：0.637，0.819）、82.93%（95% CI：0.714，0.905），特异性分别为71.19%（95% CI：0.669，0.854）、68.64%（95% CI：0.637，0.812）、89.83%（95% CI：0.809，0.934），曲线下面积分别为0.713（95% CI：0.610，0.816）、0.734（95% CI：0.623，0.846）、0.883（95% CI：0.815，0.952）。结论 β₂-MG、N/LPR与SAP患者并发AKI有关，两者在SAP患者并发AKI中具有正向交互作用，其联合预测SAP患者并发AKI效能良好。

Abstract:

Objective To investigate the value of β₂-microglobulin (β₂-MG) and the neutrophils to lymphocytes and platelets ratio (N/LPR) in predicting acute kidney injury (AKI) in patients with severe acute pancreatitis (SAP).Methods The 159 SAP patients admitted to our hospital from January 2021 to March 2024 were prospectively selected. Patients were divided into the AKI and non-AKI groups according to the occurrence of AKI during hospitalization. The clinical data including β₂-MG and N/LPR before treatment were collected. The levels of β₂-MG and N/LPR in the AKI group and the non-AKI group and the factors affecting the concurrent AKI in SAP patients were analyzed. The interaction between β₂-MG and N/LPR on the concurrent AKI in SAP patients and the value of β₂-MG and N/LPR in predicting AKI in SAP patients were determined.Results There were no statistically significant differences between the two groups in terms of sex composition, age, body mass index, SAP type distribution, underlying diseases, coronary heart disease, smoking history, alcohol consumption history, complications of abdominal compartment syndrome, systemic inflammatory response syndrome, shock, triglycerides, total cholesterol, white blood cell count, amylase, hemoglobin, and fibrinogen (P > 0.05). The APACHE II score and levels of blood lactate, blood creatinine, urea nitrogen, cystatin C, C-reactive protein, β₂-MG, and N/LPR in the AKI group were higher than those in the non-AKI group (P < 0.05). The results of multivariable stepwise Logistic regression analysis (P = 0.05 for including variables and P = 0.10 for excluding variables) showed that the levels of β₂-MG [O^R = 4.314 (95% CI: 1.673, 11.125) ], N/LPR [O^R = 3.991 (95% CI: 1.193, 13.353) ], blood creatinine [O^R = 4.444 (95% CI: 1.410 14.005) ] and cystatin C [O^R = 8.919 (95% CI: 1.904, 41.788) ], as well as the interaction between β₂-MG and N/LPR [O^R = 5.692 (95% CI: 1.945, 16.652) ] were factors affecting concomitant AKI in patients with SAP (P < 0.05). The ROC curve analysis exhibited that the sensitivities of β₂-MG, N/LPR and their combination in predicting concomitant AKI in SAP patients were 68.85% (95% CI: 0.603, 0.741), 70.73% (95% CI: 0.637, 0.819), and 82.93% (95% CI: 0.714, 0.905), with the specificity being 71.19% (95% CI: 0.669, 0.854), 68.64% (95% CI: 0.637, 0.812), and 89.83% (95% CI: 0.809, 0.934), and the areas under curves being 0.713 (95% CI: 0.610, 0.816), 0.734 (95% CI: 0.623, 0.846) and 0.883 (95% CI: 0.815, 0.952).Conclusions β₂-MG and N/LPR are associated with AKI in SAP patients, and they have a positive interaction between each other. Their combined prediction shows good efficacy in identifying AKI in SAP patients.