血清细胞黏附分子对脓毒症急性肾损伤的预测价值研究

背景　细胞黏附分子是急性重症脓毒症造成器官功能障碍（例如肾损伤）的生物标志物，但目前尚不明确血清细胞黏附分子是否对脓毒症急性肾损伤（AKI）的预测有临床价值。　目的　研究血清细胞黏附分子对脓毒症AKI的预测价值。方法　选择2016年1月—2017年12月南通大学附属医院急诊重症监护室（EICU）的84例脓毒症患者为研究对象，根据AKI的诊断标准将患者分为AKI组和非AKI组。入院后24 h内收集患者的临床资料，计算患者急性生理学和慢性健康状况（APACHE）Ⅱ评分、序贯器官衰竭评估（SOFA）评分、查尔森共病指数（CCI）评分，检测患者炎性指标〔C反应蛋白（CRP）、降钙素原（PCT）、乳酸（LAC）〕及血清细胞黏附分子〔细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、血小板选择素（P-selectin）、内皮选择素（E-selectin）〕表达水平。采用Pearson相关分析探讨炎性指标、血清细胞黏附分子与AKI严重程度的关系，采用受试者工作特征（ROC）曲线下面积（AUC）评价炎性指标、血清细胞黏附分子对脓毒症AKI的预测价值。结果　AKI组患者入院后24 h内出现休克、需要机械通气治疗的比例、APACHE Ⅱ评分、SOFA评分、血清肌酐（Scr）、LAC、ICAM-1、VCAM-1、E-selectin水平高于非AKI组（P<0.05）。Pearson相关分析结果显示，E-selectin与Scr呈正相关（r=0.223，P=0.041）。CRP、PCT、LAC、ICAM-1、VCAM-1和E-selectin预测脓毒症AKI的AUC分别为0.523〔95%CI（0.421，0.687）〕、0.637〔95%CI（0.435，0.618）〕、0.609〔95%CI（0.529，0.781）〕、0.702〔95%CI（0.619，0.846）〕，0.661〔95%CI（0.503，0.794）〕、0.774〔95%CI（0.623，0.871）〕，其中，E-selectin的诊断效能最高，其预测脓毒症AKI的最佳截断值为117.2 μg/L（灵敏度79.8%，特异度71.0%）。结论　脓毒症AKI的患者病死率高于脓毒症患者，而E-selectin与AKI的严重程度相关，是预测脓毒症AKI的重要临床标志物。

Prognostic Value of Serum Cell Adhesion Molecules in Septic Acute Kidney Injury

Background Cell adhesion molecules are biomarkers of organ dysfunction caused by acute severe sepsis(such as kidney injury),but it is not clear whether serum cell adhesion molecules have clinical value in the prediction of acute kidney injury(AKI)in sepsis.Objective To study the predictive value of serum cell adhesion molecules for AKI in sepsis.Methods From January 2016 to December 2017,84 patients with sepsis from the EICU,Affiliated Hospital of Nantong University were enrolled,and were divided into AKI group and non-AKI group(AKI was identified by the relevant diagnostic criteria).The clinical data were collected within 24 hours after admission,and the Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore,sequential organ failure assessment(SOFA),and Charlson comorbidity index(CCI)were calculated.The inflammatory indices such as C-reactive protein(CRP),procalcitonin(PCT),lactate(LAC)and the levels of serum cell adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),platelet selectin(p-selecin),endothelial selectin(E-selectin)were measured.Pearson correlation analysis was used to analyze the relationships of inflammatory indices,serum cell adhesion molecule with AKI severity.ROC curve analysis was used to evaluate the relationships of inflammatory indices,and serum cell adhesion molecule with AKI prognosis.Results The incidence of shock,the proportion of receiving mechanical ventilation,mean APACHEⅡscore,SOFA score,Scr,LAC,ICAM-1,VCAM-1 and E-selectin in AKI group were higher than those in non-AKI group(P<0.05).Pearson correlation analysis showed that E-selectin was positively correlated with Scr(r=0.223,P=0.041).For predicting septic AKI,the area under the ROC curve(AUC)of CRP,PCT,LAC,ICAM-1,VCAM-1 and E-selectin was 0.523〔95%CI(0.421,0.687)〕,0.637〔95%CI(0.435,0.618)〕,0.609〔95%CI(0.529,0.781)〕,0.702〔95%CI(0.619,0.846)〕,0.661〔95%CI(0.503,0.794)〕,0.774〔95%CI(0.623,0.871)〕,respectively,among which the predictive value of E-selectin was the largest,with a predictive value of 117.2μg/L(79.8%sensitivity and 71.0%specificity).Conclusion The mortality of patients with septic AKI is higher than that of patients with sepsis.E-selectin is related to the severity of AKI,which may be an important clinical marker for predicting AKI in sepsis.