成纤维细胞因子 23对急性肾损伤的诊断价值研究

目的探究成纤维细胞因子 23(FGF23)对急性肾损伤( AKI)的诊断价值。方法选取 2022年 2—7月山西医科大学第一医院重症医学科收治的 105例 AKI病人( AKI组)和 203例非 AKI病人(非 AKI组)为研究对象，检测两组病人的血浆 FGF23水平，并将 AKI组病人根据改善全球肾脏病预后组织( KDIGO)标准分期进行亚组分析；采用 Spearman相关性分析法分析 FGF23浓度与各指标间的相关性；采用多因素 logistic回归分析法分析 AKI的危险因素；绘制受试者操作特征曲线(ROC曲线)，计算曲线下面积( AUC)，探究血浆 FGF23水平对 AKI的诊断效能。结果两组病人在年龄、身体质量指数( BMI)方面均差异无统计学意义( P>0.05)；与非 AKI组病人相比， AKI组的 ICU住院时间、总住院时间较高( P<0.001)； AKI组病人在急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)、血清肌酐、尿素、血浆 FGF23水平［27(20，32)分、 179(108.10，293.90)μmol/L、14.70(9.54，21.22)mmol/L、169.83(164.83，174.83)ng/L］等方面均高于非 AKI组［16(12，21)分、 61(48.10，77.80)μmol/L、5.53(4.03，8.05)mmol/L、139.83(124.83，156.50)ng/L］(P<0.001)； AKI组的肾小球滤过率、尿量均低于非 AKI组( P<0.001)； AKI不同分期血浆 FGF23水平随分期的递增而逐渐升高( P<0.05)，且 1和 3期、 2和 3期组间比较差异有统计学意义( P<0.05)； Scr浓度、 FGF23水平是 AKI的独立危险因素； FGF23用于诊断 AKI的灵敏度( 87.6%)高于 Scr，其特异度( 90.6%)与 Scr相差不大。结论 FGF23是 AKI的独立危险因素，对 AKI有较高的诊断价值。

Diagnostic value of fibroblast growth factor 23 in acute kidney injury

Objective To explore the diagnostic value of fibroblast growth factor 23 (FGF23) in acute kidney injury (AKI).Methods A total of 105 AKI patients (AKI group) and 203 non-AKI patients (non-AKI group) admitted to the Department of Critical Care Medicine of the First Hospital of Shanxi Medical University from February 2022 to July 2022 were selected as the research objects. Plasma FGF23 levels were measured in the two groups, and the AKI patients were divided into subgroups according to Kidney Disease: Improv·ing Global Outcomes (KDIGO) staging criteria. Correlations between FGF23 concentrations and each index were analyzed by Spear-man''s correlation. Multivariate Logistic regression analysis was used to analyze the risk factors of AKI. The receiver operating characteristic curve was drawn and the area under the curve (AUC) was calculated to explore the diagnostic efficacy of plasma FGF23 level forAKI.Results There were no significant differences in age and body mass index (BMI) between the two groups (P>0.05). Compared with the non-AKI group patients, the AKI group had higher ICU length of stay and total hospital length of stay, which were statistically significant (P<0.001). APACHEⅡ score, creatinine, urea and plasma FGF23 levels [27 (20, 32) points, 179 (108.10, 293.90) μmol/L,14.70 (9.54, 21.22) mmol/L, 169.83 (164.83, 174.83) ng/L] in AKI group were higher than those in non-AKI group [16 (12, 21) points,61 (48.10, 77.80) μmol/L, 5.53 (4.03, 8.05) mmol/L, 139.83 (124.83, 156.50) ng/L], and the differences were statistically significant (P<0.001). The glomerular filtration rate and urine volume in AKI group were lower than those in non-AKI group (P<0.001). The level of plasma FGF23 in different stages of AKI increased gradually with increasing AKI stages (P<0.01), and the difference between the two groups in stages 1 and 3, stages 2 and 3 were statistically significant (P<0.05). Scr concentration and FGF23 level were independent risk factors for AKI. The sensitivity of FGF23 in the diagnosis of AKI (87.6%) was higher than that of Scr, and its specificity (90.6%)was similar to that of Scr.Conclusion FGF23 is an independent risk factor for AKI and has high diagnostic value for AKI.