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解放军总医院医学创新研究部、国家老年疾病临床医学研究中心(解放军总医院)、解放军总医院第六医学中心心血管病医学部
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
代仔怡,闫新明,武卫东,马天龙,朱洪伍,杨基,郭仙杰.肝素结合蛋白联合降钙素原对脓毒症相关急性肾损伤死亡风险的预测价值[J].中华老年多器官疾病杂志,2022,21(9):660~664
肝素结合蛋白联合降钙素原对脓毒症相关急性肾损伤死亡风险的预测价值
Predictive value of heparin binding protein and procalcitonin for mortality risk in patients with sepsis associated acute kidney injury
投稿时间:2022-05-19  
DOI:10.11915/j.issn.1671-5403.2022.09.143
中文关键词:  肝素结合蛋白  降钙素原  脓毒症  急性肾损伤  预后
英文关键词:heparin binding protein  procalcitonin  sepsis  acute kidney injury  prognosis This work was supported by the Key Project of Research and Development Plan of Shanxi Province
基金项目:山西省重点研发计划(指南)项目(201603D321065)
作者单位E-mail
代仔怡 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032
湖北文理学院附属医院·襄阳市中心医院:急诊科,湖北 襄阳 441000 
1943730288@qq.compredictive 
闫新明 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032 1943730288@qq.compredictive 
武卫东 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 重症医学科,太原 030032 1943730288@qq.compredictive 
马天龙 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032 1943730288@qq.compredictive 
朱洪伍 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032 1943730288@qq.compredictive 
杨基 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032 1943730288@qq.compredictive 
郭仙杰 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院 急诊外科,太原 030032 1943730288@qq.compredictive 
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中文摘要:
      目的 探讨血清肝素结合蛋白(HBP)联合降钙素原(PCT)对脓毒症相关急性肾损伤(SA-AKI)患者28d死亡风险的预测价值。方法 回顾性分析2020年7月至2022年2月山西白求恩医院急诊科重症监护室(ICU)收治的75例SA-AKI患者的临床资料。根据28d转归情况将患者分为生存组(51例)和死亡组(24例),比较2组患者HBP、PCT等情况。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ2检验进行组间比较。采用单因素分析和多因素logistic回归分析SA-AKI患者28d死亡风险的独立影响因素。绘制森林图比较SA-AKI患者死亡风险的独立影响因素差异。绘制受试者工作特征(ROC)曲线评估SA-AKI患者28d死亡危险因素的预测价值。结果 死亡组和生存组HBP[115.66(96.87,255.20)和95.61(46.82,114.79)ng/mL]、PCT[29.13(26.03,111.53)和14.41(6.62,23.91)ng/mL]、血乳酸[3.90(1.75,6.93)和2.02(1.47,4.08)mmol/L]、急性生理与慢性健康状况评分[25.50(21.25,31.00)和20.00(16.00,26.25)分]、序贯器官衰竭评分[(11.46±3.68)和(8.69±3.50)分]、住院时间[9.00(5.50,19.75)和21.50(15.00,30.00)d]、使用机械通气支持治疗[24(100.%)和35(68.6%)],使用血管收缩性药物[22(91.7%)和32(62.7%)]情况比较,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,HBP(OR=1.155,95%CI 1.007~1.325)、PCT(OR=2.698,95%CI 1.003~7.254)、住院时间(OR=0.379,95%CI 0.144~0.995)是SA-AKI患者28d预后的独立影响因素。ROC曲线结果显示,HBP预测的曲线下面积(AUC)为0.755,最佳截断值为65.815ng/ml,灵敏度为58.3%,特异度为78.4%;PCT预测的AUC为0.871,最佳截断值为20.670ng/ml,灵敏度为100.0%,特异度为64.7%;两者联合检测的AUC为0.903,最佳截断值为0.222ng/ml,灵敏度为100.0%,特异度为70.6%。结论 血清HBP和PCT水平升高是SA-AKI患者28d死亡的独立危险因素。血清HBP、PCT水平对SA-AKI患者28d死亡具有良好的预测价值,两者联合检测预测效能最佳。
英文摘要:
      Objective To investigate the predictive value of serum heparin binding protein (HBP) and procalcitonin (PCT) for 28-day mortality risk in patients with sepsis associated acute kidney injury (SA-AKI). Methods A retrospective analysis was performed of the clinical data of 75 SA-AKI patients admitted to the intensive care unit (ICU) of Emergency Department in Shanxi Bethune Hospital from July 2020 to February 2022. They were divided into the survival group (n=51) and death group (n=24) based on 28-day outcome, and the two groups were compared in HBP, PCT and other clinical data. SPSS statistics 26.0 was used for data analysis. Depending on the data type, t-test, Mann-Whitney U test, or χ2 test was used for comparison between groups. Univariate analysis and multivariate logistic regression were used to analyze the factors influencing the risk of death at 28 days, and forest plots were drawn to compare the independent prognostic factors. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of 28-day death risk factors. Results The two groups differed significantly in HBP [115.66 (96.88,255.20) vs 95.61(46.82,114.79) ng/ml], PCT [29.13(26.03,111.53) vs 14.41(6.62,23.91) ng/ml], lactic acid [3.90(1.75,6.93) vs 2.02(1.47,4.08) mmol/L], APACHE Ⅱ [25.50 (21.25,31.00) vs 20.00(16.00,26.25) points], SOFA [(11.46±3.68) vs (8.69±3.50) points], hospital stay [9.00(5.50,19.75) vs 21.50(15.00,30.00) d], use of mechanical ventilation support [24(100.0%) vs 35(68.6%)], and use of vasoconstrictor [22(91.7%) vs 32(62.7%)] (P<0.05). Logistic regression analysis showed that HBP (OR= 1.155, 95% CI 1.007-1.325), PCT (OR=2.698,95% CI 1.003-7.254) and hospital stay (OR= 0.379,95%CI 0.144-0.995) were independent influencing factors for death at 28 days in the SA-AKI patients. ROC curve analysis showed an area under the curve (AUC) of 0.755 for HBP with an optimal cut-off value of 65.815 ng/ml, a sensitivity of 58.3% and a specificity of 78.4%; an AUC of 0.871 for PCT with an optimal cut-off value of 20.670 ng/ml, a sensitivity of 100.0% and a specificity of 64.7%; and an AUC of 0.903 both with an optimal cut-off value of 0.222 ng/ml, a sensitivity of 100.0% and a specificity of 70.6%. Conclusion Elevated serum levels of HBP and PCT were independent risk factors for 28-day death in SA-AKI patients. Serum levels of HBP and PCT have good predictive value for 28-day death in SA-AKI patients, and they predict better in combination than individually.
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