可溶性血栓调节蛋白在脓毒症急性肾损伤预测价值的研究

doi:10.3969/j.issn.1002-1949.2018.07.006

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摘要目的评估内皮细胞损伤相关的生物标记物预测脓毒症急性肾损伤（AKI）发生的价值。方法本研究分析了2015-07~2017-10期间我院重症监护室收治的114例脓毒症患者。采用预后肌酐标准来确定AKI患者，包括需行肾脏替代治疗的患者。由APACHEⅡ评分和SOFA评分衡量病情严重程度。将单因素分析中有统计学差异的参数纳入Logistic回归模型中进行多因素分析，确定AKI的独立预测因素。结果最终114例脓毒症患者符合纳入和排除标准，其中非AKI组63例，AKI组51例。两组年龄、性别、BMI、感染部位等差异无统计学意义（P＞0.05）。AKI组与非AKI组比较APACHEⅡ评分、SOFA评分、慢性肾功能不全、感染性休克、弥散性血管内凝血、机械通气、ICU停留时间、CRRT、28 d病死率差异均有统计学意义（P＜0.05）。内皮细胞标志物中，AKI组较非AKI组sTM（11.9±3.3和7.6±2.1, P＜0.001）、E-选择素（65.7±13.5和45.5±10.5, P＜0.001）和PAI-1（178.6±32.6和75.5±21.0, P＜0.001）均有显著升高，而蛋白C水平显著降低（45.6±9.6和56.8±11.3, P＜0.001）。凝血生物标志物中，AKI组血小板计数、FDP、PT、ATⅢ、纤溶酶原和α2-PI与非AKI组比较差异均有统计学意义（P＜0.05）。sTM具有高特异度（98%），但敏感度有限（55%），AUC为0.735（P＜0.001）。多因素Logistic回归分析显示sTM是AKI的独立预测因子（OR：0.74, 95%CI0.35~1.24，P=0.033）。结论内皮生物标志物在AKI脓毒症患者中发生显著变化。sTM是脓毒症AKI的独立预测因子，其优于其他凝血和炎症生物标志物以及器官功能。

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	郭峻氚
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关键词 ：急性肾损伤, 脓毒症, 内皮损伤, 可溶性血栓调节蛋白, 蛋白质C

通讯作者: 肖东（1964-），女，硕士生导师，主任医师，E-mail：xiao1972dong@163.com。

作者简介: 郭峻氚（1983-），男，硕士，主治医师，E-mail: guojun1986chuan@163.com。

引用本文:

郭峻氚，刘琪，肖东. 可溶性血栓调节蛋白在脓毒症急性肾损伤预测价值的研究[J]. 中国急救医学, 2018, 38(7): 590-595.
Guo Jun-chuan, Liu Qi, Xiao Dong. Predictive value of soluble thrombomodulin in acute renal injury induced by sepsis. Chinese Journal of Critical Care Medicine, 2018, 38(7): 590-595.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.07.006 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I7/590

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