HMGB1、MCP-1水平与脓毒症合并AKI患者预后的相关性

doi:10.11958/20242035

摘要/Abstract

摘要：

目的分析高迁移率族蛋白B1（HMGB1）、单核细胞趋化蛋白-1（MCP-1）水平与脓毒症合并急性肾损伤（AKI）患者预后的相关性。方法选取脓毒症合并AKI行持续性肾脏替代治疗（CRRT）的患者100例，收集其治疗前的临床资料；在CRRT前后采用酶联免疫吸附试验检测HMGB1和MCP-1水平。CRRT治疗结束后当日开始随访，随访终点为30 d内患者死亡或生存，根据生存情况将患者分为死亡组（31例）和生存组（69例）。采用Cox回归分析HMGB1、MCP-1与脓毒症AKI患者行CRRT后30 d内死亡的关系，采用受试者工作特征（ROC）曲线分析HMGB1、MCP-1对脓毒症合并AKI患者预后的评估价值。结果生存组的序贯器官衰竭（SOFA）评分、急性生理学和慢性健康Ⅱ（APACHEⅡ）评分低于死亡组（P<0.05）。CRRT治疗后，生存组HMGB1、MCP-1水平低于死亡组（P<0.05）。Cox回归分析显示，SOFA评分、APACHEⅡ评分，治疗后HMGB1、MCP-1升高是脓毒症合并AKI患者死亡的危险因素。ROC曲线分析显示，SOFA评分、APACHEⅡ评分，治疗后HMGB1和MCP-1联合诊断的曲线下面积（AUC）为0.973，明显高于单独检测（P<0.05）。结论治疗后外周血HMGB1、MCP-1水平升高是脓毒症合并AKI患者经CRRT治疗后30 d死亡的独立危险因素，联合预测患者预后的价值较高。

关键词: 脓毒症, 急性肾损伤, 连续性肾替代疗法, 预后, HMGB1蛋白质, MCP-1

Abstract:

Objective To analyze the correlation between the levels of high mobility group protein B1 (HMGB1), monocyte chemotactic protein-1 (MCP-1) and the prognosis of patients with sepsis combined with acute kidney injury (AKI). Methods A total of 100 patients with sepsis combined with AKI treated with continuous renal replacement therapy (CRRT) were included in this study and clinical data before treatment were collected. The levels of HMGB1 and MCP-1 were detected by enzyme-linked immunosorbent assay before and after CRRT treatment. Follow-up began on the day after the end of CRRT treatment, and the end point of follow-up was death or survival within 30 days. Patients were divided into the death group (31 cases) and the survival group (69 cases) according to survival status. Cox regression was used to analyze the relationship between HMGB1 and MCP-1 and death within 30 days after CRRT in patients with septic AKI. Receiver operating characteristics (ROC) curve was used to analyze the prognostic value of HMGB1 and MCP-1 in patients with sepsis combined with AKI after CRRT. Resluts The sequential organ failure (SOFA) scores, acute physiology and chronic health Ⅱ (APACHE Ⅱ) scores were lower in the survival group than those in the death group (P<0.05). After CRRT treatment, HMGB1 and MCP-1 levels were lower in the survival group than those in the death group (P<0.05). Cox regression analysis showed that SOFA score, APACHE Ⅱscore, HMGB1 and MCP-1 increase after treatment were risk factors for death in patients with sepsis complicated with AKI. ROC curve analysis showed that the AUC of SOFA score, APACHE Ⅱ score, combined diagnosis of HMGB1 and MCP-1 after treatment was 0.973, which was significantly higher than that of single detection (P<0.05). Conclusion The increased levels of HMGB1 and MCP-1 in peripheral blood after treatment are independent risk factors for 30-day death in patients with sepsis complicated with AKI after CRRT treatment, and the combined prognostic value is high.

Key words: sepsis, acute kidney injury, continuous renal replacement therapy, prognosis, HMGB1 protein, MCP-1

中图分类号:

R631，R692.5

图/表 5

参考文献 16

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组别	n	年龄/ 岁	性别（男/女）		BMI/ （kg/m²）	SOFA 评分/分		APACHEⅡ 评分/分	CRRT持续时间/d		Scr/ （μmol/L）	CRP/ （mg/L）	BUN/ （mmol/L）		eGFR/[mL/ （min·1.73 m²）]
生存组	61	54.33±7.01	32/29		25.67±4.10	10.67±1.24		10.92±2.10	5.0（4.0，8.0）		344.79±115.04	199.96±48.49	24.72±6.99		20.95（15.04，31.19）
死亡组	39	56.46±6.94	26/13		25.13±3.96	12.33±1.06		14.74±2.70	6.0（4.0，8.0）		387.23±126.90	207.23±51.26	21.96±6.63		20.54（10.00，29.78）
t、Z或χ²		1.490	1.971		0.652	6.926^＊＊		7.934^＊＊	0.089		1.728	0.714	1.965		0.866
组别		ALT/（U/L）		AST/（U/L）		PCT/（ng/L）		WBC/（×10⁹/L）		PLT/（×10⁹/L）			APTT/s	PT/s			INR
生存组		39.56±9.96		55.91±11.16		12.35±4.47		14.26±4.96		125.64（87.89，166.90）			38.79±9.93	15.15±2.26			1.45（0.96，1.79）
死亡组		42.41±10.12		59.73±12.38		11.56±4.93		13.84±6.73		144.51（108.07，173.91）			41.25±10.10	15.60±2.19			1.44（0.78，1.77）
t或Z		1.387		1.595		0.819		0.351		1.572			1.201	0.983			0.339
吃组别			ALB/ （g/L）		TBIL/ （μmol/L）		血清钠/ （mmol/L）		血清钾/ （mmol/L）		血清钙/（mmol/L）	血清磷/（mmol/L）			糖尿病	冠心病		肝炎
生存组			31.91±8.22		34.69±4.50		137.36±7.86		4.41±0.96		2.01±0.33	1.51±0.23			18	22		12
死亡组			29.63±7.96		33.12±5.17		139.23±5.21		4.70±0.85		1.92±0.50	1.54±0.27			15	19		10
t或χ²			1.364		1.617		1.311		1.541		1.098	0.595			0.863	1.574		0.494

组别	n	年龄/ 岁	性别（男/女）		BMI/ （kg/m²）	SOFA 评分/分		APACHEⅡ 评分/分	CRRT持续时间/d		Scr/ （μmol/L）	CRP/ （mg/L）	BUN/ （mmol/L）		eGFR/[mL/ （min·1.73 m²）]
生存组	61	54.33±7.01	32/29		25.67±4.10	10.67±1.24		10.92±2.10	5.0（4.0，8.0）		344.79±115.04	199.96±48.49	24.72±6.99		20.95（15.04，31.19）
死亡组	39	56.46±6.94	26/13		25.13±3.96	12.33±1.06		14.74±2.70	6.0（4.0，8.0）		387.23±126.90	207.23±51.26	21.96±6.63		20.54（10.00，29.78）
t、Z或χ²		1.490	1.971		0.652	6.926^＊＊		7.934^＊＊	0.089		1.728	0.714	1.965		0.866
组别		ALT/（U/L）		AST/（U/L）		PCT/（ng/L）		WBC/（×10⁹/L）		PLT/（×10⁹/L）			APTT/s	PT/s			INR
生存组		39.56±9.96		55.91±11.16		12.35±4.47		14.26±4.96		125.64（87.89，166.90）			38.79±9.93	15.15±2.26			1.45（0.96，1.79）
死亡组		42.41±10.12		59.73±12.38		11.56±4.93		13.84±6.73		144.51（108.07，173.91）			41.25±10.10	15.60±2.19			1.44（0.78，1.77）
t或Z		1.387		1.595		0.819		0.351		1.572			1.201	0.983			0.339
吃组别			ALB/ （g/L）		TBIL/ （μmol/L）		血清钠/ （mmol/L）		血清钾/ （mmol/L）		血清钙/（mmol/L）	血清磷/（mmol/L）			糖尿病	冠心病		肝炎
生存组			31.91±8.22		34.69±4.50		137.36±7.86		4.41±0.96		2.01±0.33	1.51±0.23			18	22		12
死亡组			29.63±7.96		33.12±5.17		139.23±5.21		4.70±0.85		1.92±0.50	1.54±0.27			15	19		10
t或χ²			1.364		1.617		1.311		1.541		1.098	0.595			0.863	1.574		0.494

组别	n		HMGB1/（μg/L）
组别	n		治疗前		治疗后		t
生存组	61		141.67±33.07		109.41±25.23		6.046^＊＊
死亡组	39		153.92±34.57		127.60±27.64		3.869^＊＊
t			1.775		3.388^＊＊
组别		MCP-1/（pg/L）
组别		治疗前		治疗后		t
生存组		121.23±28.21		104.49±21.23		3.717^＊＊
死亡组		130.96±29.10		118.73±22.04		2.008
t		1.662		3.226^＊＊

组别	n		HMGB1/（μg/L）
组别	n		治疗前		治疗后		t
生存组	61		141.67±33.07		109.41±25.23		6.046^＊＊
死亡组	39		153.92±34.57		127.60±27.64		3.869^＊＊
t			1.775		3.388^＊＊
组别		MCP-1/（pg/L）
组别		治疗前		治疗后		t
生存组		121.23±28.21		104.49±21.23		3.717^＊＊
死亡组		130.96±29.10		118.73±22.04		2.008
t		1.662		3.226^＊＊

变量	β	SE	Wald χ²	P	HR	95%CI
治疗后MCP-1	0.016	0.008	4.474	0.034	1.016	1.001~1.031
治疗后HMGB1	0.022	0.007	10.594	0.001	1.022	1.009~1.036
APACHEⅡ评分	0.195	0.048	16.244	<0.001	1.216	1.105~1.337
SOFA评分	0.757	0.163	21.587	<0.001	2.133	1.549~2.935