脓毒症患儿尿肝型脂肪酸结合蛋白、血清热休克蛋白72水平检测对早期急性肾损伤及预后的评估价值

目的:探讨尿肝型脂肪酸结合蛋白(L-FABP)及血清热休克蛋白72(Hsp72)对脓毒症患儿继发急性肾损伤(AKI)及预后的预测价值。方法:选取2018年6月至2021年4月都江堰市妇幼保健院儿童重症监护病房(PICU)收治的脓毒症患儿216例，根据其是否发生AKI分为AKI组(80例)和非AKI组(136例),并根据AKI的分期标准进一步将AKI组分为AKI-1期组(28例)、AKI-2期组(23例)及AKI-3期组(29例)。根据28 d的生存情况将患儿分为存活组(165例)和死亡组(51例)。比较各组尿L-FABP、血清Hsp72水平；采用受试者工作特征(ROC)曲线评估尿L-FABP、血清Hsp72水平对脓毒症患儿继发AKI及预后的预测价值；采用单因素Logistic回归法分析尿L-FABP、血清Hsp72水平升高与脓毒症患儿继发AKI和发生死亡的风险相关性。结果:AKI组患儿尿L-FABP、血清Hsp72水平高于非AKI组(P<0.05);尿L-FABP、血清Hsp72水平AKI-3期组>AKI-2期组>AKI-1期组>非AKI组；死亡组尿L-FABP...

Evaluation Value of Urinary Liver Type Fatty Acid Binding Protein and Heat Shock Protein 72 in Early Acute Kidney Injury and Prognosis in Children with Sepsis

To explore the predictive value of urinary liver type fatty acid binding proteins (L-FABP) and serum heat shock proteins (Hsp72) on acute kidney injury (AKI) and prognosis in children with sepsis. Methods: Totally 216 children with sepsis treated in the pediatric intensive care unit (PICU) of Dujiangyan Maternal and Child Health Hospital from Jun. 2018 to Apr. 2021 were extracted to be divided into the AKI group (n = 80) and non-AKI group (n = 136) according to the occurrence of AKI. According to the staging standard of AKI, AKI group was further divided into the AKI-1 group (n = 28), AKI-2 group (n = 23) and AKI-3 group (n = 29). According to the 28 d survival, the children were divided into the survival group (n = 165) and death group (n = 51). The levels of urinary L-FABP and serum Hsp72 among different groups were compared. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of urinary L-FABP and serum Hsp72 levels for secondary AKI and prognosis in children with sepsis. Univariate Logistic regression was used to analyze the correlation between the elevated levels of urinary L-FABP and serum Hsp72 and the risk of secondary AKI and death in children with sepsis. Results: The levels of urinary L-FABP and serum Hsp72 in AKI group were higher than those in non-AKI group (P<0. 05). The levels of urinary L-FABP and serum Hsp72 in AKI-3 group > AKI-2 group > AKI-1 group > non-AKI group, the differences were statistically significant (P<0. 05). The levels of urinary L-FABP and serum Hsp72 in the death group were higher than those in the survival group (P<0. 05). ROC curve showed that area under the curve (AUC) of urinary L-FABP, serum Hsp72 and urinary L-FABP + serum Hsp72 in predicting secondary AKI in children with sepsis were 0. 893, 0. 823 and 0. 920. The AUC of urinary L-FABP + serum Hsp72 was higher than that of serum urinary L-FABP and serum Hsp72 ( Z was respectively 5. 819, 4. 972, P< 0. 05). The sensitivity and specificity were 89. 4% and 80. 6% respectively. The AUC of urinary LFABP, serum Hsp72 and urinary L-FABP + serum Hsp72 in predicting the prognosis of children with sepsis were 0. 786, 0. 817 and 0. 902. The AUC of urinary L-FABP + serum Hsp72 was higher than that of urinary L-FABP and serum Hsp72 (Z was respectively 4. 763, 3. 796, P<0. 05). The sensitivity and specificity were 89. 6% and 80. 9% respectively. Univariate Logistic regression analysis showed that the elevated levels of urinary L-FABP and serum Hsp72 were significantly correlated with the risk of secondary AKI and death in children with sepsis (P<0. 05). Conclusion: Urinary L-FABP and serum Hsp72 are effective indicators to predict secondaryAKI and prognosis in children with sepsis. The combination of the two indicators is helpful to improve the efficiency of AKI diagnosis andprognosis evaluation.