脓毒症并发急性肾损伤患者血清MMP-13、VASH-1水平与预后相关性

doi:10.11958/20230928

天津医药 ›› 2023, Vol. 51 ›› Issue (12): 1360-1264.doi: 10.11958/20230928

脓毒症并发急性肾损伤患者血清MMP-13、VASH-1水平与预后相关性

管光辉(), 浦秦华, 钱何布()

苏州大学附属苏州九院重症医学科（邮编215200）

收稿日期:2023-06-20 修回日期:2023-07-18 出版日期:2023-12-15 发布日期:2023-12-22
通讯作者: ^△ E-mail：qhbcxl@163.com
作者简介:管光辉（1977），男，副主任医师，主要从事脓毒症诊治方面研究。E-mail：guangh3917@163.com
基金资助:
江苏省卫生健康委科研项目(H2021013)

Correlation between serum levels of MMP-13, VASH-1 and prognosis in patients with sepsis complicated with acute kidney injury

GUAN Guanghui(), PU Qinhua, QIAN Hebu()

Department of Intensive Care Medicine, the Ninth Hospital Affiliated to Suzhou University, Suzhou 215200, China

Received:2023-06-20 Revised:2023-07-18 Published:2023-12-15 Online:2023-12-22
Contact: ^△ E-mail：qhbcxl@163.com

管光辉, 浦秦华, 钱何布. 脓毒症并发急性肾损伤患者血清MMP-13、VASH-1水平与预后相关性[J]. 天津医药, 2023, 51(12): 1360-1264.

GUAN Guanghui, PU Qinhua, QIAN Hebu. Correlation between serum levels of MMP-13, VASH-1 and prognosis in patients with sepsis complicated with acute kidney injury[J]. Tianjin Medical Journal, 2023, 51(12): 1360-1264.

摘要/Abstract

摘要：

目的探究脓毒症并发急性肾损伤（AKI）患者血清基质金属蛋白酶-13（MMP-13）、血管生成抑制蛋白-1（VASH-1）水平与入院后28 d内死亡的关系。方法选取120例脓毒症并发AKI患者（AKI组）和117例单纯脓毒症患者（非AKI组），另选取同期136例体检健康者为对照组。收集所有受试者基本资料并检测肾功能，酶联免疫吸附法检测血清MMP-13和VASH-1水平；观察脓毒症并发AKI患者入院起28 d内的生存情况，分为生存组83例和死亡组37例。比较对照组、非AKI组、AKI组及AKI组不同预后患者基本资料、肾功能、血清MMP-13、VASH-1水平；Pearson法分析脓毒症并发AKI患者血清MMP-13和VASH-1水平的相关性；Logistic回归分析影响脓毒症并发AKI患者入院后28 d内死亡的因素；受试者工作特征（ROC）曲线分析血清MMP-13和VASH-1对脓毒症并发AKI患者入院后28 d内死亡的预测价值。结果与非AKI组比较，AKI组急性生理学和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评分（SOFA）显著升高（P<0.05）；与对照组和非AKI组比较，AKI组血清血肌酐（Scr）、尿素氮（BUN）水平显著升高（P<0.05）。与对照组比较，非AKI组、AKI组血清MMP-13和VASH-1水平依次升高（P<0.05）。脓毒症并发AKI患者血清MMP-13和VASH-1水平呈正相关（r=0.650，P<0.05）。与生存组比较，死亡组APACHE Ⅱ评分、SOFA、血清Scr、BUN、MMP-13和VASH-1水平显著升高（P<0.05）。APACHE Ⅱ评分、血清MMP-13、VASH-1水平升高是脓毒症并发AKI患者入院后28 d内死亡的独立危险因素（P<0.05）。血清MMP-13、VASH-1、二者联合预测脓毒症并发AKI患者入院后28 d内死亡的曲线下面积（AUC）分别为0.810、0.837、0.903，二者联合预测的AUC大于血清MMP-13和VASH-1单独预测的AUC（P<0.05）。结论血清MMP-13和VASH-1水平在脓毒症并发AKI患者中升高，且可影响脓毒症并发AKI患者预后，对入院后28 d内死亡有较高预测价值。

关键词: 脓毒症, 急性肾损伤, 基质金属蛋白酶-13, 血管生成抑制蛋白-1, 28天内死亡

Abstract:

Objective To investigate the relationship between serum matrix metalloproteinase-13 (MMP-13) and vashohibin-1 (VASH-1) levels and death within 28 days after admission in patients with sepsis complicated with acute kidney injury (AKI). Methods A total of 120 patients with sepsis complicated with AKI (the AKI group) and 117 patients with simple sepsis without complicated AKI (the non-AKI group) were selected, and 136 healthy subjects during the same period were selected as the control group. Basic data of all subjects were collected, and renal function was detected. Serum MMP-13 and VASH-1 levels were detected by enzyme-linked immunosorbent assay. The survival of patients with sepsis complicated with AKI within 28 days after admission was observed. Patients were divided into the survival group (83 cases) and the death group (37 cases). The basic information, renal function, serum MMP-13 and VASH-1 levels were compared between patients in the control group, the non-AKI group, the AKI group and patients in the AKI group with different prognosis. The correlation between serum MMP-13 and VASH-1 levels in patients with sepsis complicated with AKI was analyzed by Pearson method. Logistic regression analysis was used to analyze the factors affecting the death of patients with sepsis complicated with AKI within 28 days after admission. The predictive value of serum MMP-13 and VASH-1 to death within 28 days after admission in patients with sepsis complicated with AKI was analyzed by receiver operating characteristic (ROC) curve. Results Compared with the non-AKI group, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score were significantly increased in the AKI group (P<0.05). Compared with the control group and the non-AKI group, serum creatinine (Scr) and blood urea nitrogen (BUN) levels were significantly increased in the AKI group (P<0.05). Compared with the control group, serum levels of MMP-13 and VASH-1 were increased successively in the non-AKI group and the AKI group (P<0.05). Serum MMP-13 and VASH-1 levels were positively correlated with sepsis patients complicated with AKI (r=0.650, P<0.05). Compared with the survival group, APACHE Ⅱ score, SOFA score, serum Scr, BUN, MMP-13 and VASH-1 levels were significantly increased in the death group (P<0.05). APACHE Ⅱ score, serum MMP-13 and VASH-1 levels were independent risk factors for the death in patients with sepsis complicated with AKI within 28 days after admission (P<0.05). The area under curve (AUC) of serum MMP-13, VASH-1 and their combination predict mortality within 28 days after admission in sepsis patients with AKI were 0.810, 0.837 and 0.903, respectively. The AUC predicted by the combination of MMP-13 and VASH-1 was significantly higher than that predicted by serum MMP-13 and VASH-1 alone (P<0.05). Conclusion Serum MMP-13 and VASH-1 levels are increased in patients with sepsis complicated with AKI, which could affect the prognosis of sepsis patients complicated with AKI, and have a high predictive value for death within 28 days after admission.

Key words: sepsis, acute kidney injury, matrix metalloproteinase-13, vashohibin-1, death within 28 days

中图分类号:

R459.7，R692

图/表 7

参考文献 18

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组别	n		BMI/ （kg/m²）		高血压史（有/无）		糖尿病史（有/无）	血管活性药物使用（有/无）
对照组	136		22.61±2.17		—		—	—
非AKI组	117		22.74±2.32		32/85		23/94	49/68
AKI组	120		22.96±2.45		34/86		27/93	65/55
χ²或F			0.740		0.028		0.287	3.582
组别		APACHE Ⅱ评分/分		SOFA/分		Scr/ （μmol/L）			BUN/ （μmol/L）
对照组		—		—		76.18±9.02			5.99±0.83
非AKI组		20.15±3.08		8.58±1.59		78.81±10.69			6.08±0.92
AKI组		24.08±4.59		12.57±2.26		124.12±17.25^ab			8.28±2.17^ab
F或t		7.720^＊＊		15.683^＊＊		552.452^＊＊			101.412^＊＊

组别	n		BMI/ （kg/m²）		高血压史（有/无）		糖尿病史（有/无）	血管活性药物使用（有/无）
对照组	136		22.61±2.17		—		—	—
非AKI组	117		22.74±2.32		32/85		23/94	49/68
AKI组	120		22.96±2.45		34/86		27/93	65/55
χ²或F			0.740		0.028		0.287	3.582
组别		APACHE Ⅱ评分/分		SOFA/分		Scr/ （μmol/L）			BUN/ （μmol/L）
对照组		—		—		76.18±9.02			5.99±0.83
非AKI组		20.15±3.08		8.58±1.59		78.81±10.69			6.08±0.92
AKI组		24.08±4.59		12.57±2.26		124.12±17.25^ab			8.28±2.17^ab
F或t		7.720^＊＊		15.683^＊＊		552.452^＊＊			101.412^＊＊

组别	n	MMP-13	VASH-1
对照组	136	22.58±3.69	307.39±45.27
非AKI组	117	63.46±7.81^a	364.42±51.63^a
AKI组	120	94.76±12.22^ab	485.76±69.98^ab
F		2 330.340^＊＊	330.060^＊＊

组别	n	MMP-13	VASH-1
对照组	136	22.58±3.69	307.39±45.27
非AKI组	117	63.46±7.81^a	364.42±51.63^a
AKI组	120	94.76±12.22^ab	485.76±69.98^ab
F		2 330.340^＊＊	330.060^＊＊

组别	n	性别（男/女）	年龄/岁	BMI/ （kg/m²）	高血压史/ （有/无）	糖尿病史/（有/无）	血管活性药物使用/（有/无）	APACHE Ⅱ评分/分	SOFA/分	Scr/ （μmol/L）	BUN/ （μmol/L）
生存组	83	50/33	63.67±8.32	22.78±2.51	22/61	18/65	47/36	19.15±3.28	10.72±2.11	119.34±13.92	7.74±1.80
死亡组	37	22/15	64.68±9.26	23.36±2.32	12/25	9/28	18/19	35.14±7.53	16.72±2.60	134.84±24.72	9.49±3.00
χ²或t		0.007	0.593	1.196	0.443	0.102	0.656	16.251^＊＊	13.367^＊＊	4.376^＊＊	3.960^＊＊

脓毒症并发急性肾损伤患者血清MMP-13、VASH-1水平与预后相关性

Correlation between serum levels of MMP-13, VASH-1 and prognosis in patients with sepsis complicated with acute kidney injury

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组别	n	MMP-13	VASH-1
生存组	83	81.78±10.24	437.61±63.81
死亡组	37	123.88±16.66	593.77±83.82
t		16.968^＊＊	11.202^＊＊

变量	β	SE	Waldχ²	P	OR	OR 95% CI
APACHE Ⅱ评分	0.076	0.028	7.367	0.007	1.079	1.021~1.140
MMP-13	0.042	0.015	7.840	0.005	1.043	1.013~1.074
VASH-1	0.010	0.004	6.250	0.012	1.010	1.002~1.018
常数项	-12.015	2.162	30.884	0.000	0.000

变量	截断值/ (ng/L)	AUC	AUC95%CI	敏感度/ %	特异度/ %	约登指数
MMP-13	102.16	0.810	0.728~0.875	72.97	85.54	0.585
VASH-1	513.46	0.837	0.758~0.898	67.57	86.75	0.543
二者联合		0.903	0.835~0.949	89.19	84.34	0.735

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