脓毒症患儿尿肝型脂肪酸结合...急性肾损伤及预后的评估价值_杨珊.pdf

(6):346-353.34 阮婉芬,潘敏仪.静脉与口服消炎痛治疗早产儿动脉导管未闭的比较J.中华当代医学,2004,2(3):13-14.35 陆长东,李其,何爱兰,等.静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭疗效比较J.实用儿科临床杂志,2004,19(7):558-559.36 SIVANANDAN S,AGARWAL R.Pharmacological closure of patent ductus arteriosus:selecting the agent and route of administration J.Paediatr Drugs,2016,18(2):123-138.37 EDISON P E,CHEN S,YEO C L,et al.Pharmacokinetics of oral versus intravenous ibuprofen for closure of patent ductus arteriosus:a pilot randomised controlled study J.J Paediatr Child Health,2021.doi:10.1111/jpc.15720.38 NEUMANN R,SCHULZKE S M,BHRER C.Oral ibuprofen versus intravenous ibuprofen or intravenous indomethacin for the treatment of patent ductus arteriosus in preterm infants:a systematic review and Meta-analysis J.Neonatology,2012,102(1):9-15.(编辑:杨丹)(收稿日期:2021-09-21 修回日期:2021-12-28)doi:10.13407/ki.jpp.1672-108X.2023.07.010论著脓毒症患儿尿肝型脂肪酸结合蛋白、血清热休克蛋白 72 水平检测对早期急性肾损伤及预后的评估价值脓毒症患儿尿肝型脂肪酸结合蛋白、血清热休克蛋白 72 水平检测对早期急性肾损伤及预后的评估价值杨珊,贾文(四川省都江堰市妇幼保健院,成都 611830)摘要目的:探讨尿肝型脂肪酸结合蛋白(L-FABP)及血清热休克蛋白 72(Hsp72)对脓毒症患儿继发急性肾损伤(AKI)及预后的预测价值。方法:选取 2018 年 6 月至 2021 年 4 月都江堰市妇幼保健院儿童重症监护病房(PICU)收治的脓毒症患儿 216 例,根据其是否发生 AKI 分为 AKI 组(80 例)和非 AKI 组(136 例),并根据 AKI 的分期标准进一步将 AKI 组分为 AKI-1 期组(28例)、AKI-2 期组(23 例)及 AKI-3 期组(29 例)。根据 28 d 的生存情况将患儿分为存活组(165 例)和死亡组(51 例)。比较各组尿 L-FABP、血清 Hsp72 水平;采用受试者工作特征(ROC)曲线评估尿 L-FABP、血清 Hsp72 水平对脓毒症患儿继发 AKI 及预后的预测价值;采用单因素 Logistic 回归法分析尿 L-FABP、血清 Hsp72 水平升高与脓毒症患儿继发 AKI 和发生死亡的风险相关性。结果:AKI 组患儿尿 L-FABP、血清 Hsp72 水平高于非 AKI 组(PAKI-2 期组AKI-1 期组非 AKI 组;死亡组尿 L-FABP、血清 Hsp72 水平高于存活组(P0.05)。ROC 曲线显示,尿 L-FABP、血清 Hsp72和尿 L-FABP+血清 Hsp72 预测脓毒症患儿继发 AKI 的曲线下面积(AUC)为 0.893、0.823、0.920,尿 L-FABP+血清 Hsp72 的AUC 高于尿 L-FABP、血清 Hsp72(Z 分别为 5.819、4.972,P0.05),其灵敏度和特异度分别为 89.4%和 80.6%;尿 L-FABP、血清 Hsp72 和尿 L-FABP+血清 Hsp72 预测脓毒症患儿预后的 AUC 为 0.786、0.817、0.902,尿 L-FABP+血清 Hsp72 的 AUC 高于尿L-FABP、血清 Hsp72(Z 分别为 4.763、3.796,P0.05),其灵敏度和特异度分别为 89.6%和 80.9%。Logistic 回归分析显示,尿L-FABP、血清 Hsp72 水平升高与脓毒症患儿继发 AKI 和发生死亡的风险显著相关(P0.05)。结论:尿 L-FABP、血清 Hsp72 是预测脓毒症患儿继发 AKI 及预后的有效指标,两者联合检测有助于提高 AKI 诊断和预后评估的效能。关键词脓毒症;急性肾损伤;肝型脂肪酸结合蛋白;热休克蛋白 72中图分类号R978.6 文献标识码A 文章编号1672-108X(2023)07-0036-05Evaluation Value of Urinary Liver Type Fatty Acid Binding Protein and Heat Shock Protein 72 in Early Acute Kidney Injury and Prognosis in Children with SepsisYang Shan,Jia Wen(Maternal and Child Health Care Hospital of Dujiangyan,Chengdu 611830,China)AbstractObjective:To explore the predictive value of urinary liver type fatty acid binding proteins(L-FABP)and serum heat shock proteins(Hsp72)on acute kidney injury(AKI)and prognosis in children with sepsis.Methods:Totally 216 children with sepsis treated in the pediatric intensive care unit(PICU)of Dujiangyan Maternal and Child Health Hospital from Jun.2018 to Apr.2021 were extracted to be divided into the AKI group(n=80)and non-AKI group(n=136)according to the occurrence of AKI.According to the staging standard of AKI,AKI group was further divided into the AKI-1 group(n=28),AKI-2 group(n=23)and AKI-3 group(n=29).According to the 28 d survival,the children were divided into the survival group(n=165)and death group(n=51).The levels of urinary L-FABP and serum Hsp72 among different groups were compared.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of urinary L-FABP and serum Hsp72 levels for secondary AKI and prognosis in children with sepsis.Univariate Logistic regression was used to analyze the correlation between the elevated levels of urinary L-FABP and serum Hsp72 and the risk of secondary AKI and death in children with sepsis.Results:The levels of urinary L-FABP and serum Hsp72 in AKI group were 63儿科药学杂志 2023 年第 29 卷第 7 期 Journal of Pediatric Pharmacy 2023,Vol.29,No.7作者简介:杨(1983.06-),女,大学本科,副主任医师,主要从事儿科临床工作,E-mail:zeyang200606 。珊higher than those in non-AKI group(P AKI-2 group AKI-1 group non-AKI group,the differences were statistically significant(P0.05).The levels of urinary L-FABP and serum Hsp72 in the death group were higher than those in the survival group(P0.05).ROC curve showed that area under the curve(AUC)of urinary L-FABP,serum Hsp72 and urinary L-FABP+serum Hsp72 in predicting secondary AKI in children with sepsis were 0.893,0.823 and 0.920.The AUC of urinary L-FABP+serum Hsp72 was higher than that of serum urinary L-FABP and serum Hsp72(Z was respectively 5.819,4.972,P0.05).The sensitivity and specificity were 89.4%and 80.6%respectively.The AUC of urinary L-FABP,serum Hsp72 and urinary L-FABP+serum Hsp72 in predicting the prognosis of children with sepsis were 0.786,0.817 and 0.902.The AUC of urinary L-FABP+serum Hsp72 was higher than that of urinary L-FABP and serum Hsp72(Z was respectively 4.763,3.796,P0.05).The sensitivity and specificity were 89.6%and 80.9%respectively.Univariate Logistic regression analysis showed that the elevated levels of urinary L-FABP and serum Hsp72 were significantly correlated with the risk of secondary AKI and death in children with sepsis(P28 d 18 岁。排除标准:既往接受过肾脏移植手术;既往有慢性肾脏疾病;使用过肾毒性药物;梗阻或肿瘤等引起的肾功能不全;入组前使用过糖皮质激素;入组前已存在急性肾损伤;临床资料不全或家长拒绝