PCT、IL-6、CysC联合检测对脓毒症急性肾损伤诊断及预后评估的价值

doi:10.11958/20240835

摘要/Abstract

摘要：

目的探讨降钙素原（PCT）、白细胞介素6（IL-6）、胱抑素（CysC）联合检测在脓毒症急性肾损伤（AKI）诊断及预后评估中的价值。方法 100例脓毒症患者根据AKI发生情况分为AKI组（n=56）和无AKI组（n=44）；AKI患者分为存活组（n=32）和死亡组（n=24）。收集患者临床资料，采用酶联免疫吸附试验检测PCT、IL-6、CysC水平；急性生理功能和慢性健康状况评分（APACHEⅡ）评估病情；采用受试者工作特征（ROC）曲线评估PCT、IL-6、CysC对脓毒症合并AKI诊断及死亡的预测价值。结果 AKI组男性比例、年龄、高血压合并糖尿病比例、APACHEⅡ评分、血肌酐（Scr）、PCT、IL-6、CysC水平高于非AKI组，合并症比例、发病时间低于非AKI组（P<0.05）。ROC曲线结果显示，PCT、IL-6、CysC联合诊断脓毒症合并AKI的曲线下面积（AUC）为0.859，敏感度为91.07%，特异度为90.91%，联合诊断效能优于单一指标。死亡组APACHEⅡ评分、PCT、IL-6、CysC水平高于存活组（P<0.05）。ROC曲线结果显示，PCT、IL-6、CysC联合预测脓毒症合并AKI患者死亡的AUC为0.847，敏感度为91.67%，特异度为87.50%，联合预测效能优于单一指标。结论联合PCT、CysC、IL-6指标对脓毒症合并AKI诊断以及预后预测的价值更高。

关键词: 脓毒症, 急性肾损伤, 预后, 降钙素原, 白细胞介素6, 半胱氨酸蛋白酶抑制物C

Abstract:

Objective To explore the diagnostic and prognostic values of procalcitonin (PCT), interleukin 6 (IL-6) and cystatin C (CysC) combined detection in sepsis acute kidney injury (AKI).Methods A total of 100 patients with sepsis were divided into the AKI group (n=56) and the non AKI group (n=44) according to the occurrence of AKI. The prognosis of AKI patients was followed up, and patients were divided into the survival group (n=32) and the death group (n=24) according to the presence or absence of death. Enzyme-linked immunosorbent assay (ELISA) was used to detect PCT, IL-6 and CysC in different groups of patients. The Acute Physiological Function and Chronic Health Status Score (APACHEⅡ) was used to assess the condition of illness. ROC curve was used to analyze the predictive values of PCT, IL-6 and CysC in the diagnosis and death of sepsis combined with AKI.Results The male ratio, age, hypertension with diabetes ratio, APACHE Ⅱ score, serum creatinine (Scr), PCT, IL-6 and CysC levels were higher in the AKI group than those in the non AKI group, and the ratio of complications and onset time were lower in the AKI group than those in the non AKI group (P<0.05). The ROC curve results showed that the area under the curve (AUC) of PCT, IL-6, and CysC combined for the diagnosis of sepsis complicated with AKI was 0.859, with a sensitivity of 91.07% and a specificity of 90.91%. The combined diagnostic efficacy was better than that of a single indicator. The APACHE Ⅱ score, PCT, IL-6 and CysC levels were higher in the death group than those in the survival group (P<0.05). The ROC curve results showed that the AUC, sensitivity and specificity of PCT, IL-6 and CysC combined in predicting mortality in sepsis patients with AKI were 0.847, 91.67% and 87.50%, respectively. The combined predictive efficacy was better than that of single indicator.Conclusion The combination of PCT, CysC and IL-6 indicators is more valuable in diagnosing and predicting prognosis of sepsis with AKI.

Key words: sepsis, acute kidney injury, prognosis, procalcitonin, interleukin-6, cystatin C

中图分类号:

R692

图/表 6

参考文献 26

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组别	n	性别（男/女）	年龄/ 岁	BMI/ （kg/m²）	感染部位^①	合并症^②
非AKI组	44	25/19	56.08±18.25	22.29±2.96	4/30/3/7	4/5/3/32
AKI组	56	43/13	65.14±15.87	22.55±3.10	1/43/8/4	11/8/14/23
χ²或t		4.515^＊	2.652^＊	0.425	5.850	11.272^＊
组别		发病时间/d	机械通气	感染性休克	APACHEⅡ 评分/分	心率/ （次/min）
非AKI组		9.34±2.52	23（52.27）	25（56.82）	18.00±7.03	103.25±21.04
AKI组		5.80±1.60	32（57.14）	42（75.00）	24.63±7.08	108.59±22.40
χ²或t		8.551^＊	0.236	3.684	4.663^＊	1.215
组别		SBP/ mmHg	DBP/ mmHg		MAP/ mmHg	24 h尿量/ mL
非AKI组		110.73±25.32	68.23±17.85		82.39±19.08	1 355.82±402.37
AKI组		104.11±21.74	64.29±15.48		77.56±16.77	1 226.91±309.84
t		1.406	1.181		1.345	1.811
组别		Scr/ （μmol/L）		WBC/ （×10⁹/L）		PCT/ （μg/L）
非AKI组		88.83±21.72		14.27±3.79		11.00±3.00
AKI组		310.80±96.20		13.65±3.68		28.00±8.00
t		14.993^＊		0.825		13.365^＊
组别		IL-6/ （ng/L）		CysC/ （mg/L）		死亡
非AKI组		91.88±8.12		1.46±0.39		15（11.36）
AKI组		201.02±15.27		3.14±0.94		24（42.86）
t或χ²		42.857^＊		11.118^＊		0.796

组别	n	性别（男/女）	年龄/ 岁	BMI/ （kg/m²）	感染部位^①	合并症^②
非AKI组	44	25/19	56.08±18.25	22.29±2.96	4/30/3/7	4/5/3/32
AKI组	56	43/13	65.14±15.87	22.55±3.10	1/43/8/4	11/8/14/23
χ²或t		4.515^＊	2.652^＊	0.425	5.850	11.272^＊
组别		发病时间/d	机械通气	感染性休克	APACHEⅡ 评分/分	心率/ （次/min）
非AKI组		9.34±2.52	23（52.27）	25（56.82）	18.00±7.03	103.25±21.04
AKI组		5.80±1.60	32（57.14）	42（75.00）	24.63±7.08	108.59±22.40
χ²或t		8.551^＊	0.236	3.684	4.663^＊	1.215
组别		SBP/ mmHg	DBP/ mmHg		MAP/ mmHg	24 h尿量/ mL
非AKI组		110.73±25.32	68.23±17.85		82.39±19.08	1 355.82±402.37
AKI组		104.11±21.74	64.29±15.48		77.56±16.77	1 226.91±309.84
t		1.406	1.181		1.345	1.811
组别		Scr/ （μmol/L）		WBC/ （×10⁹/L）		PCT/ （μg/L）
非AKI组		88.83±21.72		14.27±3.79		11.00±3.00
AKI组		310.80±96.20		13.65±3.68		28.00±8.00
t		14.993^＊		0.825		13.365^＊
组别		IL-6/ （ng/L）		CysC/ （mg/L）		死亡
非AKI组		91.88±8.12		1.46±0.39		15（11.36）
AKI组		201.02±15.27		3.14±0.94		24（42.86）
t或χ²		42.857^＊		11.118^＊		0.796

组别	AUC	95%CI	Cut-off值	敏感度/%	特异度/%	约登指数
PCT	0.706	0.649~0.763	20.00 μg/L	80.36	75.00	0.554
IL-6	0.642	0.591~0.693	150.00 ng/L	69.64	68.18	0.378
CysC	0.752	0.706~0.794	2.00 mg/L	85.71	79.55	0.653
联合	0.859	0.769~0.949	-	91.07	90.91	0.820

组别	AUC	95%CI	Cut-off值	敏感度/%	特异度/%	约登指数
PCT	0.706	0.649~0.763	20.00 μg/L	80.36	75.00	0.554
IL-6	0.642	0.591~0.693	150.00 ng/L	69.64	68.18	0.378
CysC	0.752	0.706~0.794	2.00 mg/L	85.71	79.55	0.653
联合	0.859	0.769~0.949	-	91.07	90.91	0.820

组别		n	性别（男/女）					年龄/ 岁					BMI/ （kg/m²）		感染部位^①					合并症^②
存活组		32	23/9					64.56±15.92					22.51±3.16		1/23/4/4					7/5/6/14
死亡组		24	20/4					65.92±15.77					22.61±3.02		0/20/4/0					4/3/8/9
χ²或t			1.010					0.318					0.119		4.151					1.580
组别	发病时间/d						机械通气		感染性休克					APACHEⅡ 评分/分					心率/ （次/min）
存活组	5.71±1.34						19（59.38）		23（71.88）					22.53±6.12					106.81±21.98
死亡组	5.92±1.95						13（54.17）		19（79.17）					27.42±7.30					110.96±22.72
t或χ²	0.478						0.152		0.389					2.724^＊					0.689
组别						SBP/ mmHg						DBP/ mmHg				MAP/ mmHg
非AKI组						105.31±22.93						66.91±15.09				79.71±16.86
AKI组						102.50±19.92						60.79±15.30				74.69±16.21
t						0.480						1.493				1.121
组别				24 h尿量/ mL							Scr/ （μmol/L）						WBC/ （×10⁹/L）
非AKI组				1 245.82±318.74							324.66±95.43						13.61±3.81
AKI组				1 201.70±297.97							292.38±97.23						13.71±3.51
t				0.527							1.243						0.101
组别					PCT/ （μg/L）					IL-6/ （ng/L）								CysC/ （mg/L）
非AKI组					25.90±6.00					161.42±10.06								2.91±0.87
AKI组					30.80±10.70					253.82±22.22								3.45±1.03
t					2.178^＊					20.887^＊								2.124^＊