【摘要】 目的 探究血清学指标联合序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分对重症急性肾损伤(acute kidney injury,AKI)患者预后的预测价值。方法 回顾性分析2015年12月至2020年12月桐乡市第一人民医院收治的80例重症AKI患者的临床资料,根据28d生存情况将其分为生存组(n=53)和死亡组(n=27)。比较两组患者的临床资料,采用Pearson法分析血浆中性粒细胞明胶酶相关脂质运载蛋白(plasma neutrophil gelatinase-associatedlipocalin,pNGAL)水平与胱抑素C(cystatin C,CysC)、血肌酐(serum creatinine,SCr)、SOFA评分的相关性,绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析各参数预测重症AKI患者预后的诊断价值。结果两组患者的性别、年龄、体质量指数、基础疾病、AKI病因、血尿素氮及尿酸水平比较差异均无统计学意义(P>0.05),死亡组患者的pNGAL、CysC、SCr水平及SOFA评分均显著高于生存组(P<0.05);重症AKI患者pNGAL水平与CysC、SCr、SOFA评分均呈正相关(r=0.529、0.531、0.523,P<0.05);pNGAL、CysC、SCr及SOFA评分单独及联合预测重症AKI患者预后的曲线下面积分别为0.776、0.813、0.838、0.837、0.902。结论 pNGAL、CysC、SCr及SOFA评分与重症AKI患者的病情严重程度密切相关,上述指标联合检测对重症AKI患者28d内病死率具有较高的预测价值,对合理制定治疗方案及预后评估有一定指导作用。更多还原

【Abstract】 Objective To explore the prognostic value of serological indexes combined with sequential organ failure assessment(SOFA) score in patients with severe acute kidney injury(AKI). Methods The clinical data of 80 patients with severe AKI admitted to Tongxiang First People’s Hospital from December 2015 to December 2020 were retrospectively analyzed. According to the 28d survival, they were divided into survival group(n=53) and death group(n=27). The clinical data of both groups were compared, and the correlation between the level of plasma neutrophil gelatinase-associated lipocalin(pNGAL) and cystatin C(CysC), serum creatinine(SCr), SOFA score were analyzed by Pearson method, and receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic value of each parameter in predicting the prognosis of patients with severe AKI. Results There were no significant differences in gender, age, body mass index, underlying diseases, causes of AKI, blood urea nitrogen and uric acid levels between the two groups(P>0.05), while the levels of pNGAL, CysC, SCr and SOFA score of death group were significantly higher than those of survival group(P<0.05). The level of pNGAL in patients with severe AKI was positively correlated with CysC, SCr and SOFA score(r=0.529, 0.531, 0.523, P<0.05). The area under the curve of pNGAL, CysC, SCr and SOFA score alone and in combination to predict the prognosis of severe AKI were 0.776, 0.813, 0.838, 0.837 and 0.902,respectively. Conclusion p NGAL, CysC, SCr and SOFA scores are closely related to the severity of severe AKI patients.The combined detection of these indexes has a high predictive value for the mortality within 28 days of severe AKI patients, and has a certain guiding role in the rational development of treatment plan and prognosis evaluation.更多还原