感染性急性肾损伤肾脏替代疗法血清炎症因子评估

目的探究感染性急性肾损伤肾脏替代疗法(RRT)血清炎症因子[单核细胞趋化蛋白1(MCP-1)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6、IL-10]的评估作用。方法选取2013年3月-2019年3月黄石爱康医院肾病内科收治的感染性急性肾损伤患者132例,根据患者是否接受RRT分为RRT组和非RRT组,分别为47例和85例;采用酶联免疫吸附法检测患者血清MCP-1、TNF-α、IL-6及IL-10水平,分析上述炎症因子对患者应用RRT的评估作用。结果纳入感染性急性肾损伤患者病情危重,重症监护病房(ICU)住院期间病死率为53.79%(71/132),61例(46.21%)存活患者中28例(45.90%)肾功能逐渐恢复,33例(54.10%)肾脏丢失;血清炎症指标:两组MCP-1、IL-6及IL-10比较,差异有统计学意义(P<0.05);单项检测中MCP-1[曲线下面积(AUC)=0.718]和IL-10(AUC=0.810)的评估具有一定的准确性(AUC>0.7),联合上述血清炎症指标检测(AUC=0.915)准确性均高于各单项检测(P<0.05)。结论血清MCP-1和IL-10对于感染性急性肾损伤患者接受RRT具有一定的评估价值,但上述指标联合TNF-α、IL-6后评估价值明显提高。

Value of serum inflammatory factors in assessment of renal replacement therapy for patients with infectious acute kidney injury

OBJECTIVE To explore the value of serum inflammatory factors[monocyte chemoattractant protein 1(MCP-1),tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),IL-10]in assessment of renal replacement therapy(RRT)for the patients with infectious acute kidney injury(AKI).METHODS A total of 132 patients with infectious AKI who were treated in Huangshi Aikang Hospital from Mar 2013 to Mar 2019 were enrolled in the study and divided into the RRT group with 47 cases and the non-RRT group with 85 cases according to the status of RRT.The levels of serum MCP-1,TNF-α,IL-6 and IL-10 were detected by means of enzyme-linked immunosorbent assay(ELISA),and the value of the above inflammatory factors in prediction of RRT was analyzed.RESULTS The patients with infectious AKI showed critical illness condition,the mortality rate was 53.79%(71/132)in intensive care unit(ICU)during the hospital stay.Among 61(46.21%)patients who survived,there were 28(45.90%)patients whose renal function gradually recovered and 33(54.10%)patients whose kidneys were lost.There were significant differences in the levels of MCP-1,IL-6 and IL-10 between the two groups(P<0.05).The area under curve(AUC)of the MCP-1 was 0.718,and the AUC of the IL-10 was 0.810,both were accurate to some extent in the prediction(AUC>0.7),and the AUC of the joint detection of above inflammatory factors was 0.915,significantly higher than that of the detection of single index(P<0.05).CONCLUSION The serum MCP-1 and IL-10 have certain value in prediction of RRT for the patients with infectious AKI,and the above indexes combined with TNF-αand IL-6 has higher predictive value.