实用医学杂志 ›› 2023, Vol. 39 ›› Issue (4): 471-475.doi: 10.3969/j.issn.1006⁃5725.2023.04.015

• 临床研究 • 上一篇    下一篇

血清PGC⁃1α水平在脓毒症致急性肾损伤诊断中的价值 

李晶1,2 陆芹芹2 崔艳飞2    

  1. 1 浙江中医药大学(杭州 310053);2 绍兴第二医院重症医学科(浙江绍兴 312000)

  • 出版日期:2023-02-25 发布日期:2023-02-25
  • 基金资助:

    基金项目:绍兴市柯桥区社会发展类经费自筹科技计划项目(编号:2021KZ18)

Early diagnostic value of serum PGC⁃1α level for secondary acute kidney injury in patients with sepsis

LI Jing*,LU Qinqin,CUI Yanfei.   

  1. Zhejiang Chinese Medical University,Hangzhou 310053,China;*Department of Intensive Care Unit,Shaoxing Second Hospital,Shaoxing 312000,China

  • Online:2023-02-25 Published:2023-02-25

摘要:

目的 探讨血清过氧化物酶增殖激活受体 γ 辅助激活物 1α(PGC⁃1α)对脓毒症患者继发急 性肾损伤(AKI)的早期诊断价值。方法 选取 2019 10 月至 2022 1 月绍兴第二医院重症医学科收治 107 例脓毒症患者为研究对象,依据是否继发 AKI 将患者分为 AKI 组(n = 68)和非 AKI 组(n = 39)。比 较两组患者基线临床资料;收集确诊脓毒症时患者空腹静脉血和尿液标本,检测血清 PGC⁃1α、降钙素原 PCT)、乳酸(Lac)、肌酐(sCr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平并估算肾小球滤过率 eGFR);采用二元 logistic 回归分析脓毒症患者继发 AKI 的危险因素;采用 Spearman 相关性分析血清 PGC⁃ 1α 水平与其他临床指标的相关性;采用受试者工作特征(ROC)曲线分析 PGC⁃1α 水平对脓毒症患者发生 AKI 的预测价值。结果 两组患者年龄、性别、BMI、合并基础病史、原发感染部位比例及 Lac 水平差异无 统计学意义(P > 0.05)。AKI 组患者急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、脓毒症相关性 器官功能衰竭(SOFA)评分及 PCT、sCr、NGAL 等水平均显著高于非 AKI 组(P < 0.05),而 eGFR、PGC⁃1α 显著低于非 AKI 组(P < 0.05)。二元 logistc 回归分析模型显示,sCr、NGAL、eGFR、PGC⁃1α 是脓毒症患者继 AKI 的独立危险因素。Spearman 相关性分析显示,脓毒症患者血清 PGC⁃1α 水平与 sCr、NGAL 呈负相关 性(r = -0.302、-0.635,均 P < 0.05),而与 eGFR 呈正相关(r = 0.475,P < 0.05)。ROC 曲线分析结果显示,血 PGC⁃1α 水平对脓毒症患者继发 AKI 的诊断效能优于 NGAL eGFR。结论 PGC⁃1α 在脓毒症继发 AKI 患者的早期血清中明显升高,其或可作为脓毒症致急性肾损伤早期诊断的有效预测指标。

关键词:

脓毒症, 急性肾损伤, 过氧化物酶增殖激活受体γ辅助激活物1α, 早期诊断价值

Abstract:

Objective To investigate the early diagnostic value of peroxidase proliferation activated receptor gamma auxiliary material 1 alpha(PGC ⁃1α)for secondary acute kidney injury(AKI)in patients with sepsis. Methods A total of 107 patients with sepsis admitted to the department of critical care medicine of Shaoxing Sec⁃ ond Hospital from October 2019 to January 2022 were selected as the research objects and divided into AKI group (= 68)and non⁃AKI group(= 39)according to whether complicating secondary AKI. The baseline clinical data of the two groups were compared. Fasting venous blood and urine samples were collected at the time of diagnosis of sepsis to detect serum PGC⁃1α,procalcitonin(PCT),lactic acid(Lac),creatinine(sCr),neutrophil gelatinase⁃ associated lipocalin(NGAL)levels and estimated glomerular filtration rate(eGFR). Binary logistic regression analysis was used to analyze the risk factors of secondary AKI in patients with sepsis;Spearman correlate analysis was used to analyze between serum PGC⁃1 α level and other clinical indicators;Receiver operating characteristic (ROC)curve was used to analyze the predictive value of PGC ⁃ 1α level for AKI in patients with sepsis. Results There was no significant difference in age,sex,BMI,combined basic disease history,proportion of primary infection site,and Lac level between the two groups(> 0.05). The acute physiology and chronic evaluation Ⅱ (APACHEⅡ)score,sepsis⁃related organ failure assessment(SOFA)score and the levels of PCT,sCr and NGAL in AKI group were significantly higher than those in non ⁃AKI group(< 0.05). However,eGFR and PGC ⁃1α were significantly lower than that in non ⁃AKI group(< 0.05). Binary logistic regression analysis showed that sCr,NGAL,eGFR and PGC⁃1α were the independent risk factors for secondary AKI in patients with sepsis. Spear⁃ man correlation analysis showed that serum PGC⁃1α level in sepsis patients was negatively correlated with sCr andNGAL(= -0.302,-0.635,< 0.05),but positively correlated with eGFR(= 0.475,< 0.05). ROC curve analysis showed that the diagnostic efficacy of serum PGC⁃1α level for secondary AKI in patients with sepsis was better than that of NGAL and eGFR. Conclusion The serum level of PGC⁃1α is significantly increased in the early stage of patients with sepsis secondary AKI,which may be used as an effective predictor for early diagnosis of acute kidney injury caused by sepsis.

Key words:

sepsis, acute kidney injury, peroxidase proliferation activated receptor gamma auxiliary material 1 alpha, early diagnostic value