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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

27卷

期数:

2021年04期

页码:

365-368

栏目:

临床医学

出版日期:

2021-07-20

文章信息/Info

Title:

Prognostic value of serum NGAL combined with lactic acid and APACHEⅡscore in patients with septic shock complicated with acute kidney injury

文章编号:

1006－8147（2021）04-0365-04

作者:

彭燕¹; 许华²; 王兵²; 王勇强²

（1.天津医科大学一中心临床学院重症医学科，天津300192；2.天津市第一中心重症医学科，天津市急救医学研究所，天津300192）

Author(s):

PENG Yan¹;  XU Hua²;  WANG Bing²;  WANG Yong-qiang²

（1.Department of Critical Care Medicine，The First Center Clinical College，Tianjin Medical University，Tianjin 300192，China；2.Department of Critical Care Medicine， Tianjin First Center Hospital，Tianjin Institute of Emergency Medicine，Tianjin 300192，China）

关键词:

脓毒性休克; 急性肾损伤; 血清NGAL; APACHEⅡ评分; 血乳酸

Keywords:

septic shock;  acute renal injury;  serum NGAL;  APACHEⅡ score;  blood lactic acid

分类号:

R446.1+R631.4

DOI:

-

文献标志码:

A

摘要:

目的：探讨血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）联合急性生理和慢性健康评分（APACHEⅡ）、血乳酸对脓毒性休克所致急性肾损伤（AKI）患者病死的预测价值。方法：选择2017年9月—2020年8月我院收治的50例脓毒性休克合并AKI患者，根据患者预后分为死亡组23例、存活组27例。比较两组患者一般临床资料、血清NGAL、血肌酐、APACHEⅡ评分、血乳酸及降钙素原（PCT）等，并比较血清NGAL、APACHEⅡ评分、血乳酸单独检测与三者联合检测在预测脓毒性休克所致AKI患者病死的差别。结果：死亡组血清NGAL、血乳酸、APACHEⅡ评分检测值均明显高于存活组（Z=-3.280、Z=-2.931、t=5.013，均P<0.01）。受试者工作特征曲线（ROC曲线）分析显示，血清NGAL、APACHEⅡ、血乳酸及三者联合检测预测脓毒性休克合并AKI患者病死的曲线下面积分别为：0.793（95%CI：0.668～0.918，P<0.01）、0.813（95%CI：0.696～0.931，P<0.01）、0.675（95%CI：0.516～0.833，P<0.01）、0.885（95%CI：0.797～0.975，P<0.01），敏感性分别为87.5%、87.5%、58.3%、75%，特异性分别为65.4%、61.5%、84.6%、92.3%，约登指数分别为0.529、0.490、0.429、0.673，三者联合检测高于单独检测。结论：血清NGAL、APACHEⅡ评分、血乳酸三者联合检测对脓毒性休克所致AKI患者病死的预测有较高的临床应用价值。

Abstract:

Objective: To investigate the predictive value of serum neutrophil gelatinase-associated apolipoprotein（NGAL） combined with acute physiology and chronic health evaluation（APACHEⅡ） score and blood lactic acid in patients with acute kidney injury（AKI） induced by septic shock. Methods：From January 2017 to August 2020，50 patients with septic shock complicated with AKI were selected.According to the prognosis of the patients，they were divided into death group（n=23） and survival group（n=27）.The general clinical data，serum NGAL，serum creatinine，APACHEⅡ score，blood lactic acid and PCT were analyzed，and the differences of serum NGAL，APACHEⅡscore，blood lactic acid and their combined detection in predicting the death of patients with AKI by septic shock were compared. Results： The serum NGAL，latic acid and APACHEⅡ score in the death group were significantly higher than those in the survival group（Z=-3.280，Z=-2.931，t=5.013，all P<0.01）.Receiver operating characteristic curve（ROC curve）of the subjects showed that the areas under the curve of serum NGAL，APACHEⅡ，blood lactic acid and their combined detection in predicting the death of patients with AKI by septic shock were 0.793（95%CI：0.668-0.918，P<0.01），0.813（95%CI：0.696-0.931，P<0.01），0.675 （95%CI：0.516-0.833，P<0.01）and 0.885（95%CI：0.797-0.975，P<0.01），sensitivity was 87.5%，87.5%，58.3%，75%，specificity was 65.4%，61.5%，84.6%，92.3%，and the Jordan advised was 0.529，0.490，0.429 and 0.673. The combination detection of the three methods was higher than those of the single test. Conclusion：The combined detection of serum NGAL， APACHEⅡ score and blood lactic acid has high clinical application value in predicting death of patients with AKI by septic shock.

参考文献/References:

[1] Almalky M A，Hasan S A，Hassan T H，et al. Detection of early renal injury in children with solid tumors undergoing chemotherapy by urinary neutrophil gelatinase-associated lipocalin[J]. Mol Clin Oncol，2015，3（6）：1341
[2] Brezis M，Heyman S N，Epstein F H． Determinants of intrarenal oxygenation．II． hemodynamic effects[J]． Am J Physiol，1994，267（6 Pt 2）：F1063
[3] Chebotareva N，Bobkova I，Shilov E，et al. Heat shock proteins and kidney disease：perspectives of HSP therapy[J]. Cell Stress Chaperones，2017，22（3）：319
[4] Chang W，Zhu S，Pan C，et al. Predictive utilities of neutrophil gelatinase-associated lipocalin（NGAL） in severe sepsis[J]. Clin Chim Acta，2018，（481）：200
[5] kim H，Hur M，Lee S，et al. Proenkephalin，neutrophil gelatinase-associated lipocalin，and estimated glomerular filtration rates in patients with sepsis[J]. Ann Lab Med，2017，37（5）：388
[6] Wang B，Chen G，Zhang J，et al. Increased neutrophil gelatinase-associated lipocalin is associated with mortality and multiple organ dysfunction syndrome in severe sepsis and septic shock[J]. Shock，2015，44（3）：234
[7] Landesberg G，Levin P D，Gilon D，et al. Myocardial dysfunction in severe sepsis and septic shock[J]. Chest，2015，148（1）： 93
[8] 戴新贵． NGAL在脓毒症急性肾损伤中的应用价值[Ｄ]. 广州：南方医科大学，2017
[9] 于中锴，张宗旺，管向东. 脓毒症的研究进展[ J/CD]. 中华卫生应急电子杂志，2019，5（2）：59
[10] 孟东亮．血清和尿液 ＮＧＡＬ对脓毒症继发急性肾损伤的早期预测价值的研究[Ｄ]．温州：温州医科大学，2014
[11] 刘新龙. 血NGAL、CysC检测在外科重症AKI患者的早期诊治及预后评估中的应用价值[Ｄ].昆明：昆明医科大学，2014
[12] 林美华，郭小云，李洪钧. 腹膜透析患者血清NGAL水平与微炎症状态的关系[ J].天津医科大学学报，2013，19（5）：396
[13] Macdonald S P J，Bosio E，Neil C，et al. Resistin and NGAL are associated with inflammatory response，endothelial activation and clinical outcomes in sepsis [J]. Inflamm Res，2017，66 （7）：611
[14] 段楠，刘怡，李海霞，等. 糖化白蛋白诱导人近端肾小管上皮细胞产生创伤与炎症反应的表达[J].首都医科大学学报，2017，38（2）：289
[15] Martin-Loeches I，Guia M C，Vallecoccia M S，et al. Risk factors for mortality in elderly and very elderly ill patients with sepsis： a prospective，observational，multicenter cohort study[J]. Ann Intensive Care，2019，9（1）：26
[16] Ralib J M，Nanyan S，Ramly N F，et al. Acute kidney injury in Malaysian intensive care setting：incidences，risk factors，and outcome[J].Indian J Crit Care Med，2018，22（12）：831
[17] 许慧慧，吴维维，于航，等. 老年脓毒症诱发急性肾损伤患者血清NGAL、CysC水平变化及诊断价值研究[J]. 中国实验诊断学，2020，24（7）：1139
[18] BuonafineM，Martinez-Martinez E，Jaisser F. More than a simplebiomarker：the role of NGAL in cardiovascular and renal diseases[J].Clin Sci（Lond），2018，132（9）：909
[19] 张继松，王聿明，郑彦俊，等. NGAL对脓毒症/脓毒症休克患者预后的预测价值[J].中华卫生应急电子杂志，2020，6（4）：202
[20] van Engelen T S R，Wiersinga W J，Scicluna B P，et al. Biomarkers inSepsis[J]. Crit Care Clin，2018，34（1）：139
[21] Lelubre C，Anselin S，Zouaoui B K，et al. Interpretation of C-reactive protein concentrations in critically ill patients[J]. Biomed Res Int，2013，（2013）：124021

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备注/Memo

备注/Memo:

基金项目：天津市卫计委攻关课题（14KG101）;天津市第一中心医院科技基金（院CM201809）
作者简介：彭燕（1983-），女，主治医师，硕士在读，研究方向：急诊医学；通信作者：王勇强，E-mail：yongqiang1962@sina.com。

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更新日期/Last Update: 2021-07-25