关键词: 脓毒症, 急性肾损伤, 预后, 危险因素, 脂肪酸结合蛋白质类, 心型脂肪酸结合蛋白

Abstract: Objective To explore the predictive value of serum heart-type fatty acid binding protein (H-FABP) level for acute kidney injury (AKI) in patients with sepsis. Methods A prospective research design method was used, and 135 patients with sepsis from the Department of Intensive Medicine of Kunshan Hospital Affiliated to Jiangsu University from January 2018 to December 2019 were selected. According to whether AKI occurred during hospitalization, patients were divided into non-AKI with sepsis group (75 cases) and AKI with sepsis group (60 cases). All patients were drawn 5ml of fasting venous blood within 24 hours after diagnosis, and the blood H-FABP was detected by enzyme-linked immunosorbent assay kit. Data of the age, gender, sequential organ failure score (SOFA), oxygenation index ［p（O2）/FiO2］, past medical history (hypertension, diabetes and coronary heart disease), vital signs (respiratory rate, heart rate, body temperature and mean arterial pressure), laboratory indicators [white blood cells, platelets, urea nitrogen, blood creatinine, C-reactive protein, cardiac troponin I (cTnI), N-terminal pro-brain-type natriuretic peptide (NT-proBNP)] and auxiliary means [(vascular rise compression, tracheal intubation, continuous renal replacement therapy (CRRT)] were collected. Multivariate Logistic regression analysis was used to evaluate the independent risk factors for sepsis patients with AKI. Spearman correlation analysis showed the correlation between serum H-FABP and C-reactive protein, cTnI, NT-proBNP and SOFA score indicators. The receiver operating characteristic (ROC) curves of the above five indicators were drawn to predict the predictive value of AKI, and the areas under the curve (AUC) were compared. Results (1) The data of the age, SOFA score, C-reactive protein, cTnI, NT-proBNP, H-FABP levels and the use of vasopressors and CRRT were significantly higher in the sepsis with AKI group than those in the sepsis with non-AKI group (all P＜0.01). (2) The AUC predicted by H-FABP (0.813, 95%CI：0.737-0.875) in sepsis patients with AKI was higher than that of C-reactive protein (0.624, 95%CI：0.537-0.706), cTnI (0.641, 95%CI：0.554-0.722) and NT-proBNP (0.660, 95%CI：0.574-0.739, P＞0.05). (3) NT-proBNP≥3 367 ng/L, H-FABP≥6.2 μg/L and SOFA score≥4 were independent risk factors for sepsis patients with AKI . (4) H-FABP was positively correlated with C-reactive protein, cTnI, NT-proBNP, and SOFA (rs=0.663, 0.688, 0.727and 0.490 respectively, P＜0.01). Conclusion H-FABP may be an effective predictor for septic patients with AKI, and its increased level indicates that the risk of septic patients with AKI is higher.

Key words: sepsis, acute kidney injury, prognosis, risk factor, fatty acid-binding proteins, heart-type fatty acid-binding protein