| 刘 玮,周 倩,宋振华,徐 杰,李 剑.血清APRIL、LRG1、Syndecan-1与脓毒症合并急性肾损伤患者肾功能和短期预后的关系[J].,2024,(17):3365-3370 |
| 血清APRIL、LRG1、Syndecan-1与脓毒症合并急性肾损伤患者肾功能和短期预后的关系 |
| Relationship between Serum APRIL, LRG1, Syndecan-1 and Renal Function and Short-Term Prognosis in Patients with Sepsis Combined with Acute Kidney Injury |
| 投稿时间：2024-02-12 修订日期：2024-03-06 |
| DOI：10.13241/j.cnki.pmb.2024.17.032 |
| 中文关键词: 脓毒症 急性肾损伤 APRIL LRG1 Syndecan-1 短期预后 |
| 英文关键词: Sepsis Acute kidney injury APRIL LRG1 Syndecan-1 Short-term prognosis |
| 基金项目:济南市科技计划项目（2022-2-82）；山东省医药卫生科技发展计划项目（2019WS065） |
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| 中文摘要: |
| 摘要 目的：探讨血清增殖诱导配体（APRIL）、富亮氨酸α-2糖蛋白-1（LRG1）、多配体蛋白聚糖-1（Syndecan-1）与脓毒症合并急性肾损伤（AKI）患者肾功能和短期预后的关系。方法：选取济南市第五人民医院于2021年1月～2023年1月收治的247例脓毒症患者，根据是否合并AKI分为非AKI组（122例）和AKI组（125例），根据30d临床结局将脓毒症合并AKI患者分为死亡组和存活组。采用酶联免疫吸附法检测血清APRIL、LRG1、Syndecan-1，并计算肾功能指标[尿白蛋白/肌酐比（UACR）、估计的肾小球滤过率（eGFR）]。Spearman相关性分析血清APRIL、LRG1、Syndecan-1与脓毒症合并AKI患者UACR、eGFR的相关性。多因素Logistic回归分析脓毒症合并AKI患者短期预后的影响因素，受试者工作特征（ROC）曲线分析血清APRIL、LRG1、Syndecan-1水平对脓毒症合并AKI患者短期预后的预测价值。结果：AKI组血清APRIL、LRG1、Syndecan-1水平和UACR高于非AKI组，eGFR低于非AKI组（P＜0.05）。Spearman相关性分析显示，血清APRIL、LRG1、Syndecan-1与脓毒症合并AKI患者UACR呈正相关，与eGFR呈负相关（P＜0.05）。125例脓毒症合并AKI患者30d死亡率为40.80%。死亡组血清APRIL、LRG1、Syndecan-1水平和UACR高于存活组，eGFR低于存活组（P＜0.05）。多因素Logistic回归分析显示，急性生理和慢性健康评估Ⅱ（APACHEⅡ）评分增加、序贯器官衰竭评估（SOFA）评分增加和UACR、APRIL、LRG1、Syndecan-1升高为脓毒症合并AKI患者短期预后的独立危险因素，eGFR升高为独立保护因素（P＜0.05）。血清APRIL、LRG1、Syndecan-1水平联合预测的曲线下面积为0.908，大于血清APRIL、LRG1、Syndecan-1水平单独预测。结论：血清APRIL、LRG1、Syndecan-1水平升高与脓毒症合并AKI患者肾功能降低密切相关，是脓毒症合并AKI患者短期预后不良的独立危险因素。血清APRIL、LRG1、Syndecan-1水平联合预测脓毒症合并AKI患者短期预后的价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between serum a proliferation-inducing ligand (APRIL), leucine-rich α-2 glycoprotein 1 (LRG1), multiligand proteoglycan-1 (Syndecan-1) and renal function and short-term prognosis in patients with sepsis combined with acute kidney injury (AKI). Methods: 247 patients with sepsis admitted to Jinan Fifth People's Hospital from January 2021 to January 2023 were selected, and patients were divided into non-AKI group (122 cases) and AKI group (125 cases) according to whether AKI was combined, patients with sepsis combine with AKI were divided into death group and survival group according to the 30 days clinical outcome. Serum APRIL, LRG1 and Syndecan-1 were detected by enzyme-linked immunosorbent assay, and renal function indexes [urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR)] were calculated. The correlation between serum APRIL, LRG1, Syndecan-1 and UACR and eGFR in patients with sepsis combine with AKI were analyzed by Spearman correlation analysis. The influencing factors of short-term prognosis in patients with sepsis combine with AKI were analyzed by multivariate Logistic regression, the predictive value of serum APRIL, LRG1 and Syndecan-1 levels for short-term prognosis in patients with sepsis combine with AKI were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of serum APRIL, LRG1, Syndecan-1 and UACR in AKI group were higher than those in non-AKI group, and eGFR was lower than that in non-AKI group (P<0.05). Spearman correlation analysis showed that, serum APRIL, LRG1 and Syndecan-1 were positively correlated with UACR and negatively correlated with eGFR in patients with sepsis combine with AKI (P<0.05). The 30 day mortality rate of 125 patients with sepsis combine with AKI was 40.80%. The levels of serum APRIL, LRG1, Syndecan-1 and UACR in death group were higher than those in survival group, and eGFR was lower than that in survival group (P<0.05). Multivariate Logistic regression analysis showed that, the increase of acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, UACR, APRIL, LRG1 and Syndecan-1 were independent risk factors for short-term prognosis in patients with sepsis combine with AKI, and the increase of eGFR was an independent protective factor (P<0.05). The area under the curve of combined prediction of serum APRIL, LRG1 and Syndecan-1 levels was 0.908, which was greater than that of serum APRIL, LRG1 and Syndecan-1 levels alone. Conclusion: The increase of serum APRIL, LRG1 and Syndecan-1 levels are closely relate to the decrease of renal function in patients with sepsis combine with AKI, and are independent risk factors for poor short-term prognosis in patients with sepsis combined with AKI. The combination of serum APRIL, LRG1 and Syndecan-1 levels has a high value in predicting the short-term prognosis in patients with sepsis combine with AKI. |
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