白细胞介素-17水平对脓毒症患者发生急性肾损伤的预测价值

目的分析脓毒症患者发生急性肾损伤(acute kidney injury,AKI)的影响因素,探讨白细胞介素(interleukin,IL)-17对脓毒症患者并发AKI的预测价值。方法102例脓毒症患者,根据入住ICU 7 d内是否发生AKI分为AKI组和非AKI组。比较2组患者一般资料及序贯器官衰竭评分(sequential organ failure assessment,SOFA)和急性生理和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ);采用ELISA法检测血清IL-17、IL-23水平,采用免疫比浊法检测降钙素原水平,并进行2组间比较;采用多因素logistic回归分析脓毒症患者发生AKI的影响因素;绘制ROC曲线,评估IL-17早期预测脓毒症患者发生AKI的效能。结果入住ICU 7 d内102例患者共发生AKI 31例,发生率为30.39%。AKI组患者平均动脉压(77.25±8.94)mm Hg]、氧合指数(233.04±19.26)mm Hg]低于非AKI组(88.17±9.38)、(254.88±18.57)mm Hg](P<0.05),SOFA评分(8.81±1.35)分]、APACHEⅡ评分(18.87±2.69)分]及血清降钙素原(4.83±0.99)μg/L]、IL-23(63.25±10.78)μg/L]、IL-17(43.85±13.27)μg/L]水平均高于非AKI组(6.94±1.52)分、(14.79±2.95)分、(3.91±1.13)μg/L、(56.88±11.75)μg/L、(31.99±7.13)μg/L](P<0.05)。平均动脉压(OR=0.877,95%CI:0.810~0.950,P=0.001)、SOFA评分(OR=2.096,95%CI:1.493~2.942,P<0.001)、降钙素原(OR=1.720,95%CI:1.052~2.812,P=0.030)、IL-17(OR=1.078,95%CI:1.014~1.145,P=0.015)是脓毒症患者发生AKI的影响因素。血清IL-17、平均动脉压、SOFA评分、降钙素原的最佳截断值分别为40.92μg/L、82.33 mm Hg、8.35分、4.22μg/L时,预测脓毒症患者发生AKI的AUC分别为0.848(95%CI:0.764~0.912,P<0.001)、0.677(95%CI:0.577~0.766,P<0.001)、0.689(95%CI:0.590~0.777,P<0.001)、0.638(95%CI:0.537~0.731,P<0.001),灵敏度分别为67.74%、93.55%、67.74%、70.97%,特异度分别为87.32%、39.55%、69.01%、50.93%。结论IL-17可对脓毒症患者是否发生AKI进行早期预警。

Value of interleukin-17 level to the prediction of acute kidney injury in patients with sepsis

Objective To investigate the influencing factors of acute kidney injury(AKI)in patients with sepsis,and to analyze the value of interleukin(IL)-17 to the prediction of AKI in patients with sepsis.Methods Totally 102 patients with sepsis were divided into AKI group(n=31)and non-AKI group(n=71)according to whether they had AKI within 7 days after entering ICU.The general data,sequential organ failure assessment(SOFA)score and acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ)score were compared between two groups.ELISA method was used to detect serum IL-17 and IL-23 levels,and immunoturbidimetric method was used to detect procalcitonin(PCT)level.The levels of IL-17,IL-23 and PCT were compared between two groups.Multivariate logistic regression analysis was used to assess the influencing factors of AKI in patients with sepsis.ROC was drawn to evaluate the efficacy of IL-17 on early predicting AKI in patients with sepsis.Results In 102 patients,AKI occurred in 31 patients(30.39%)in 7 days after entering ICU.The mean arterial pressure and oxygenation index were lower in AKI group((77.25±8.94),(233.04±19.26)mm Hg)than those in non-AKI group((88.17±9.38),(254.88±18.57)mm Hg)(P<0.05),while SOFA score,APACHE-Ⅱscore,PCT level,IL-23 level and IL-17 level were higher in AKI group(8.81±1.35,18.87±2.69,(4.83±0.99)μg/L,(63.25±10.78)μg/L,(43.85±13.27)μg/L)than those in non-AKI group(6.94±1.52,14.79±2.95,(3.91±1.13)μg/L,(56.88±11.75)μg/L,(31.99±7.13)μg/L)(P<0.05).The mean arterial pressure(OR=0.877,95%CI:0.810-0.950,P=0.001),SOFA score(OR=2.096,95%CI:1.493-2.942,P<0.001),PCT level(OR=1.720,95%CI:1.052-2.812,P=0.030)and IL-17 level(OR=1.078,95%CI:1.014-1.145,P=0.015)were the influencing factors of AKI in patients with sepsis.When the optimal cut-offvalues of serum IL-17 level,mean arterial pressure,SOFA score and PCT level were 40.92μg/L,82.33 mm Hg,8.35 and4.22μg/L,the AUCs for predicting AKI in sepsis patients were 0.848(95%CI:0.764-0.912,P<0.001),0.677(95%CI:0.577-0.766,P<0.001),0.689(95%CI:0.590-0.777,P<0.001)and 0.638(95%CI:0.537-0.731,P<0.001),the sensitivities were 67.74%,93.55%,67.74%and 70.97%,and the specificities were 87.32%,39.55%,69.01%and 50.93%,respectively.ConclusionIL-17 may be used as an early warning of AKI in patients with sepsis.