ACLF相关AKI患者的血清persepsin水平及其诊断价值研究

目的 探讨并发急性肾损伤（acute kidney injury，AKI）的慢加急性肝衰竭（acute-on-chronic liver failure，ACLF）患者血清可溶性CD14亚型（persepsin）蛋白水平改变及其用于AKI诊断的价值。方法 纳入2011年2月~2015年6月在笔者医院治疗的HBV相关ACLF患者300例，根据是否并发AKI分为AKI组（n=141）及无AKI（non-AKI）组（n=159）。患者住院时记录一般及实验室指标，检测血清persepsin及胱抑素C（cystatin C，Cys-C）水平。分析persepsin与各项指标的相关性，ROC曲线分析persepsin诊断ACLF患者AKI的效能。结果 AKI组persepsin水平（670.74±459.41pg/ml）显著高于non-AKI组（238.42±191.70pg/ml），差异有统计学意义（P=0.000）。不同AKI分期persepsin由高至低依次为：AKI-3期 >AKI-2期 >AKI-1期。AKI组患者血清persepsin与eGFR（r=-0.621，P=0.000）呈显著负相关，与TBIL（r=0.192，P=0.022）、WBC（r=0.260，P=0.002）、sCr（r=0.568，P=0.000）、Cys-C（r=0.575，P=0.000）及MELD评分（r=0.272，P=0.000）呈正相关。persepsin用于诊断ACLF并发AKI的AUC为0.836（95%CI：0.787~0.885），persepsin联合Cys-C的AUC为0.858（95%CI：0.813~0.903）。结论 persepsin水平可反映ACLF患者并发AKI时的肾功能损害严重程度，与Cys-C联合时具有良好的AKI诊断效能。

Serum Persepsin Protein Level in AKI Patients with ACLF and Its Clinical Diagnostic Value

Objective To investigate serum soluble CD14 subtype (persepsin) protein level and its clinical diagnostic value in acute kidney injury (AKI) patients with acute-on-chronic liver failure (ACLF). Methods A total of 300 patients with HBV related ACLF from February 2011 to June 2015 in our hospital were enrolled retrospectively, then they were divided into AKI group (n=141) and non-AKI group (n=159). The general information and laboratory parameters were recorded, and the serum persepsin and cystatin C (Cys-C) levels were tested. The correlations between persepsin and parameters were analyzed, and diagnostic efficiency of persepsin for AKI in patients with ACLF was calculated by ROC curve. Results The level of persepsin in AKI group (670.74±459.41pg/ml) was significantly higher than non-AKI group (238.42±191.70pg/ml)(P=0.000), and the levels of cpersepsin in different AKI stages were from high to low in order as AKI-3 >AKI-2 >AKI-1. The Persepsin levels were significantly negatively correlated with eGFR (r=-0.480, P=0.000), and positively with TBIL (r=0.192, P=0.022), WBC (r=0.260, P=0.002), sCr (r=0.568, P=0.000), Cys-C (r=0.575, P=0.000) and MELD score (r=0.272, P=0.000). AUC of Persepsin used for the diagnosis of AKI in patients with ACLF was 0.836 (95%CI: 0.787-0.885), and the AUC of persepsin combined with Cys-C was 0.858 (95%CI: 0.813-0.903). Conclusion Persepsin level reflects the severity of renal damage of AKI in patients with ACLF, and it can be used to improve the diagnosis of AKI combined with Cys-C.