摘要
目的探讨急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分联合尿中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase associated lipocalin,NGAL)对脓毒症合并急性肾损伤(acute kindey injury,AKI)的预测价值。方法选取2017年1月—2019年6月收治的脓毒症198例,依据住院7 d内是否发生AKI分为AKI组(n=68)与非AKI组(n=130)。比较两组一般资料,分析脓毒症患者发生AKI的影响因素,评估APACHEⅡ评分、尿NGAL检测对脓毒症合并AKI的诊断价值。结果与非AKI组比较,AKI组年龄>60岁、合并糖尿病、行肾脏替代治疗、行机械通气治疗所占比例升高,心率、体温、呼吸、收缩压、血肌酐、乳酸、降钙素原、APACHEⅡ评分、尿NGAL水平上升,差异有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析显示,年龄≥76岁、合并糖尿病、行机械通气治疗、APACHEⅡ评分≥19分、尿NGAL≥530μg/L是影响脓毒症患者发生AKI的独立危险因素(P<0.05或P<0.01)。受试者工作特征曲线分析显示,APACHEⅡ评分联合尿NGAL检测诊断脓毒症合并AKI的曲线下面积、敏感度、特异度高于APACHEⅡ评分、尿NGAL检测单独使用。结论APACHEⅡ评分联合尿NGAL检测预测脓毒症合并AKI的临床效能较高。
Objective To investigate the predictive value of acute physiology and chronic health evaluation(APACHE II)score combined with neutrophil gelatinase-associated lipocalin(NGAL)in sepsis combined with acute kidney injury(AKI).Methods From January 2017 to June 2019,198 patients with sepsis were treated in our hospital.According to presence or absence of AKI within 7 days after hospitalization,they were divided into AKI group(n=68)and non-AKI group(n=130).The general data of the two groups were compared,the influencing factors of AKI in patients with sepsis was analyzed,and diagnostic value of APACHEⅡscore and urine NGAL in sepsis combined with AKI was evaluated.Results Compared with non-AKI group,the proportion of patients aged 60 years or older,combined diabetes,renal replacement therapy or mechanical ventilation treatment were larger in AKI group,and heart rate,body temperature,breathing,systolic blood pressure,blood creatinine,lactic acid,procalcitonin,APACHEⅡscore and urine NGAL level were increased(P<0.05 or P<0.01).Multivariate logistic regression analysis showed that age≥76 years,combined diabetes,mechanical ventilation treatment,APACHEⅡscore≥19 points and urine NGAL≥530μg/L were independent risk factors affecting the occurrence of AKI in patients with sepsis(P<0.05 or P<0.01).ROC curve analysis showed that in the diagnosis of sepsis combined with AKI,the area under the curve,sensitivity,and specificity of APACHEⅡscore combined with urine NGAL test were higher than APACHEⅡscore and urine NGAL test alone.Conclusion APACHEⅡscore combined with urine NGAL has higher clinical efficacy in predicting sepsis combined with AKI.
作者
程晓迎
王磊
CHENG Xiao-ying;WANG Lei(Department of ICU,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《临床误诊误治》
2020年第6期57-62,共6页
Clinical Misdiagnosis & Mistherapy
基金
黑龙江省卫生计生委科研项目(2017-041)。
关键词
脓毒症
急性肾损伤
急性生理与慢性健康状况Ⅱ评分
中性粒细胞明胶酶相关载脂蛋白
肾替代疗法
乳酸
预测
Sepsis
Acute kidney injury
Acute physiology and chronic health evaluationⅡscore
Neutrophil gelatinase associated lipocalin
Renal replacement therapy
Lactic acid
Forecasting
