脓毒症患者肾损伤程度与血浆血管生成素-1、2水平相关性的研究

目的：探讨脓毒症患者肾损伤程度与血浆血管生成素-1、2水平的相关性。方法96例入住 ICU 的脓毒症患者,按 AKIN 急性肾损伤标准分为脓毒症非 AKI 组（NAKI,n =46）,AKIⅠ组（n =23）,AKIⅡ组（n =11）,AKIⅢ组（n =16）,另选取30例健康体检者作为健康对照组（CON, n =30）。登记一般情况并进行急性生理和慢性健康状况（APACHEⅡ）评分、序贯器官衰竭（SOFA）评分,采血检测血浆 Ang-1、 Ang-2、血肌酐（Scr）,计算肌酐清除率（Ccr）,统计分析其相关性。结果①与 CON 组比较,NAKI 、AKIⅠ、AKIⅡ、AKIⅢ组血浆 Ang-1水平明显降低（P 〈0.01）,四组间差异无统计学意义（P 〉0.05）；血浆 Ang-2水平明显升高（P 〈0.01）,且随 AKI 分级增高而明显升高（P 〈0.05）。②各组血浆 Ang-1水平与 Ccr 值无相关（P 〉0.05）,各组血浆 Ang-2水平与 Ccr 值呈正相关（P 〈0.01）,多元回归分析显示 Ang-2与 Ccr 值呈显著独立相关（P 〈0.01）。③血浆 Ang-1水平与 APACHEⅡ评分、SOFA 评分无相关（P 〉0.05）,血浆 Ang-2水平与 APACHEⅡ评分、SOFA 评分呈正相关（P 〈0.01）,多元回归分析显示 Ang-2与 APACHEⅡ评分、SOFA 评分均呈显著独立相关（P 〈0.05）。结论血浆 Ang-2水平是影响脓毒症患者肾损伤程度的独立危险因素。

Relationship between the Severity of Kidney Damage and the Levels of Ang-1 and Ang-2 in Patient with Sepsis

Objective To investigate the relationship between the severity of kidney damage and the level of Ang-1 and Ang-2 in patients with sepsis. Methods 96 septic patients admitted to ICU were divided into NAKI group （n = 46）,AKIⅠgroup （n = 23）,AKIⅡ group （n = 11）,AKIⅢ group （n = 16） according to different damage degrees under AKIN criteria, and 30 healthy people were also enrolled as healthy control group（n = 30）. The clinical data including the acute physiology and chronic healthy conditions（APACHE） Ⅱ score and sequential organ failure（SOFA） score were collected and recorded. Blood samples were collected to detect plasma Ang-1,Ang-2 , Scr and Ccr and correlation was analyzed. Results ①The plasma Ang-1 levels in NAKI, AKIⅠ, AKIⅡ, AKIⅢ groups were significantly lower compared with CON group （P 〈 0. 01）, but there were no difference among the four groups （P 〉 0. 05）. The plasma Ang-2 levels in NAKI, AKIⅠ,AKIⅡ,AKIⅢ groups were significantly higher compared with CON group （P 〈 0. 01）, and the plasma Ang-2 levels of the four groups significantly increased as their AKI classification increased. ②The plasma Ang-1 level and Ccr was not correlated （P 〉 0. 05）. The plasma Ang-2 level and Ccr was significant correlated （P 〈 0. 01）. Multiple linear regression analysis showed that plasma Ang-2 level was significantly independ-ently correlated with Ccr （P 〈 0. 01）. ③The plasma Ang-1 levels and the APACHEⅡ score and SOFA score were not correlated （P 〉 0. 05）. The plasma Ang-2 levels and the APACHEⅡ score and SOFA score was positively correlated （P 〈 0. 01）. Multiple linear regression analysis showed that plasma Ang-2 level was significantly independently correlated with the APACHEⅡ score and SOFA score （P 〈 0. 05）. Conclusion The plasma Ang-2 level is an independent risk factor associated with severity of kidney damage of septic patients.