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| 脓毒症并发急性肾损伤患者血浆Lp-PLA2、SIRT1表达水平及其与短期预后的关系 |
| Expression levels of plasma Lp-PLA2 and SIRT1 in patients with sepsis complicated with acute kidney injury and their relationship with short-term prognosis |
| 投稿时间：2025-03-15 修订日期：2025-03-15 |
| DOI： |
| 中文关键词: 脓毒症 急性肾损伤 短期预后 脂蛋白相关性磷脂酶A2 沉默信息调节蛋白1 |
| 英文关键词: Sepsis Acute kidney injury Short-term prognosis Lipoprotein associated phospholipase A2 Silent information regulatory protein 1 |
| 基金项目:河南省医学科技攻关计划项目（LHGJ20190865） |
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| 中文摘要: |
| 目的 探讨脓毒症并发急性肾损伤（AKI）患者血浆脂蛋白相关性磷脂酶A2（Lp-PLA2）、沉默信息调节蛋白1（SIRT1）水平变化及其与短期预后的关系。方法 前瞻性选取2022年5月～2024年5月于我院接受诊治的脓毒症患者243例，其中80例脓毒症患者并发AKI（AKI组），163例脓毒症患者未并发AKI（非AKI组），比较两组血浆Lp-PLA2、SIRT1水平。根据AKI组入院28 d的预后情况分为预后良好组和预后不良组。脓毒症合并AKI患者短期预后的影响因素采用多因素Logistic回归模型分析。血浆Lp-PLA2、SIRT1单独及联合预测脓毒症合并AKI患者短期预后价值采用受试者工作特征（ROC）曲线分析。 结果 与非AKI组比较，AKI组血浆Lp-PLA2水平升高，血浆SIRT1水平降低（P＜0.05）。AKI组入院28 d内死亡39例（预后不良组），存活41例（预后良好组），预后不良率为48.75%（39/80）。预后不良组序贯器官衰竭评分（SOFA）评分、急性生理与慢性健康状况评分II（APACHEII）评分、肌酐（Scr）、乳酸脱氢酶/白蛋白比值（LAR）均高于预后良好组，降钙素原（PCT）低于预后良好组（P＜0.05）。与预后良好组相比，入院时预后不良组血浆Lp-PLA2水平升高，血浆SIRT1水平降低（P＜0.05）。SOFA评分升高、Scr升高、APACHEII评分升高、血浆Lp-PLA2升高是脓毒症合并AKI患者预后不良危险因素（P＜0.05），血浆SIRT1升高是保护因素（P＜0.05）。ROC曲线分析结果显示，血浆Lp-PLA2、SIRT1联合检测预测脓毒症合并AKI患者预后不良的曲线下面积（AUC）为0.935，优于血浆Lp-PLA2、SIRT1单独检测预测的0.813、0.858。结论 脓毒症合并AKI患者血浆Lp-PLA2升高、血浆SIRT1下降，联合检测二者可辅助预测预后不良的发生风险。 |
| 英文摘要: |
| Objective To explore the changes in plasma lipoprotein associated phospholipase A2 (Lp-PLA2) and silencing information regulatory protein 1 (SIRT1) in patients with sepsis complicated with acute kidney injury (AKI) and their relationship with short-term prognosis. Method 243 sepsis patients who received treatment in our hospital from May 2022 to May 2024 were prospective selected, including 80 sepsis patients with AKI (AKI group) and 163 sepsis patients without AKI (non AKI group), the plasma Lp-PLA2 and SIRT1 levels between the two groups were compared. They were divided into good prognosis group and poor prognosis group according to 28d prognosis after admission in AKI group. The influencing factors of short-term prognosis in sepsis patients complicated with AKI were analyzed by multiple logistic regression model. The short-term prognostic value of plasma Lp-PLA2 and SIRT1 alone and in combination for sepsis complicated with AKI patients was analyzed using receiver operating characteristic (ROC) curve. Result Compared with non AKI group, AKI group had higher Lp-PLA2 and lower SIRT1 (P<0.05). 39 deaths within 28d after admission in AKI group (poor prognosis group), 41 cases survived (good prognosis group), with poor prognosis rate of 48.75% (39/80). Sequential organ failure assessment (SOFA) score, acutephysiology and chronic health evaluation II （APACHEII) score, creatinine (Scr), lactate dehydrogenase albumin ratio (LAR) in poor prognosis group were higher than those in good prognosis group, while procalcitonin (PCT) was lower than that in good prognosis group (P<0.05). Compared with the good prognosis group, poor prognosis group had higher Lp-PLA2 and lower SIRT1 at admission (P<0.05). Elevated SOFA score, elevated Scr, elevated APACHEII score, and elevated plasma Lp-PLA2 were risk factors for poor prognosis in sepsis patients complicated with AKI (P<0.05), while elevated plasma SIRT1 was a protective factor (P<0.05). ROC curve analysis results showed that, the combined detection of plasma Lp-PLA2 and SIRT1 predicted a poor prognosis for sepsis patients with AKI with an area under the curve (AUC) of 0.935, which was better than the prediction of 0.813 and 0.858 for plasma Lp-PLA2 and SIRT1 alone. Conclusion Sepsis complicated with AKI patients have elevated plasma Lp-PLA2 and decreased SIRT1, combined detection of the two can assist in predicting the risk of poor prognosis. |
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