[1]刘 淼a,姜 姗b,张 黎b,等.血清硫酸吲哚酚联合中期因子对医院获得性急性肾损伤患者预后的预测价值研究[J].现代检验医学杂志,2022,37(04):112-117+182.[doi:10.3969/j.issn.1671-7414.2021.04.022]
　LIU Miaoa,JIANG Shanb,ZHANG Lib,et al.Study on the Predictive Value of Serum Indoxyl Sulfate Combined with Midkine on the Prognosis of Patients with Hospital-Acquired Acute Kidney Injury[J].Journal of Modern Laboratory Medicine,2022,37(04):112-117+182.[doi:10.3969/j.issn.1671-7414.2021.04.022]
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血清硫酸吲哚酚联合中期因子对医院获得性急性肾损伤患者预后的预测价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第37卷
期数:
2022年04期
页码:
112-117+182
栏目:
论著
出版日期:
2022-07-15

文章信息/Info

Title:
Study on the Predictive Value of Serum Indoxyl Sulfate Combined with Midkine on the Prognosis of Patients with Hospital-Acquired Acute Kidney Injury
文章编号:
1671-7414（2022）04-112-07
作者:
刘 淼a; 姜 姗b; 张 黎b; 卢远航c
湖北省第三人民医院a. 检验科；b. 病理科；c. 肾病内科，武汉 430000
Author(s):
LIU Miaoa;  JIANG Shanb;  ZHANG Lib;  LU Yuan-hangc
a. Department of Clinical Laboratory; b. Department of Pathology; c.Department of Nephrology, the Third People’s Hospital of Hubei Province, Wuhan 430000,China
关键词:
医院获得性急性肾损伤; 硫酸吲哚酚; 中期因子
分类号:
R692；R446.112
DOI:
10.3969/j.issn.1671-7414.2021.04.022
文献标志码:
A
摘要:
目的 探讨医院获得性急性肾损伤（hospital-acquired acute kidney injury ，HA-AKI）患者血清硫酸吲哚酚（indoxylsulfate ，IS）与中期因子（midkine ，MK）联合检测对临床预后的预测价值。方法 回顾性分析2018 年3 月～ 2021 年3 月在湖北省第三人民医院接受治疗的HA-AKI 患者的临床资料，120 例患者根据AKI 病情严重程度分为Ⅰ期组（n=38）、Ⅱ期组（n=42）和Ⅲ期组（n=40），另选取同期体检的健康人群50 例作为健康对照组，比较各组研究对象血清IS 和MK水平。按照HA-AKI 患者住院期间是否死亡分为生存组（n=88）和死亡组（n=32），比较两组患者血清IS 和MK 水平。采用多因素Logistic 回归分析影响HA-AKI 患者住院期间死亡的危险因素，另采用受试者工作特征曲线（ROC）分析IS和MK单独以及联合预测HA-AKI 患者预后的价值。结果 HA-AKI Ⅲ期患者血清IS（3.10± 0.50μg/ml）和MK（2.33±0.38μg/L）水平明显高于Ⅱ期患者（1.85± 0.25μg/ml, 2.02 ±0.26μg/L），Ⅱ期HA-AKI 患者血清IS 和MK 水平明显高于Ⅰ期（0.78± 0.26μg/ml, 1.50 ±0.20μg/L），Ⅰ期患者血清IS 和MK 水平明显高于健康对照组（0.09± 0.03μg/ml,1.25 ±0.14μg/L）, 组间差异均有统计学意义（F=172.100，37.805，均P ＜ 0.05）。死亡组HA-AKI 患者血清IS（3.02±0.40μg/ml），MK（2.26± 0.31μg/L）水平均明显高于生存组（1.54 ±0.23μg/ml，1.85 ±0.22μg/L），差异有统计学意义（t=19.775，6.878，均P ＜ 0.05）。多因素Logistic 回归模型分析显示，高IS 水平、高MK 水平、高龄、入住重症监护室（ICU）、机械通气以及服用肾毒性药物均是影响HA-AKI 患者死亡的危险因素（均P ＜ 0.05）。MK，IS 单独及联合预测HA-AKI 患者预后的曲线下面积（AUC）分别为0.707，0.738 和0.837（均P ＜ 0.05）。结论 血清IS和MK 在HA-AKI 患者中呈高表达，在预测HA-AKI 患者预后中具有一定的价值，且两者联合应用的预测价值最高。除高IS 以及MK 水平外，高龄、入住ICU、机械通气以及服用肾毒性药物均是影响HA-AKI 患者死亡的危险因素。
Abstract:
Objective To explore the clinical predictive value of combined detection of serum indoxyl sulfate （IS） combined with midkine （MK） in patients with hospital-acquired acute kidney injury （HA-AKI）. Methods The clinical data of patients with HA-AKI who were treated in the Third People’s Hospital of Hubei Province from March 2018 to March 2021 were retrospectively analyzed. According to the severity of their AKI, the 120 patients were divided into Ⅰ stage group （n=38）, Ⅱ stage group （n=42） and Ⅲ stage group （n=40）, and 50 healthy people who received physical examination in the Third People’s Hospital of Hubei Province during the same period were selected as the healthy control group, and the serum IS and MK levels of the study subjects in each group were compared. According to whether patients with HA-AKI died during hospitalization, they were divided into survival group （n=88） and death group （n=32）. Serum IS and MK levels of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors for mortality in patients with HAAKI during hospitalization, and receiver operating characteristic curve （ROC） was used to analyze the prognostic value of IS and MK alone or in combination for patients with HA-AKI. Results The serum IS （3.10± 0.50μg/ml） and MK（2.33± 0.38μg/L） levels of HA-AKI stage Ⅲ patients were significantly higher than those of stage Ⅱ patients（1.85± 0.25μg/ml,2.02 ±0.26μg/L），the serum IS and MK levels of stage Ⅱ HA-AKI patients were significantly higher than those of stage Ⅰ（0.78± 0.26μg/ml, 1.50 ±0.20μg/L），the serum IS and MK levels of stage Ⅰ patients were significantly higher than those of healthy controls（0.09± 0.03μg/ml, 1.25 ±0.14μg/L）, the differences between groups were statistically significant （F=172.100，37.805，all P ＜ 0.05）. The serum IS （3.02± 0.40μg/ml）and MK（2.26± 0.31μg/L）levels of HA-AKI patients in the death group(1.54 ±0.23μg/ml, 1.85±0.22μg/L) were significantly higher than those in the survival group，the differences were statistically significant（t=19.775，6.878, all P ＜ 0.05）. Multivariate logistic regression model analysis showed that high IS levels, high MK levels, advanced age, admission to the intensive care unit （ICU）, mechanical ventilation, and nephrotoxic drugs were all risk factors affecting the death of HA-AKI patients （all P ＜ 0.05）. The area under the curve （AUC） of MK, IS alone and combined to predict the prognosis of HA-AKI patients were 0.707, 0.738 and 0.837 （all P ＜ 0.05）. Conclusion Serum IS and MK were highly expressed in patients with HA-AKI, and which have certain value in predicting the prognosis of patients with HA-AKI, and the combination of the two has the highest predictive value. In addition to high IS and MK levels, advanced age, admission to ICU, mechanical ventilation, and taking nephrotoxic drugs are all risk factors that affect the death of patients with HA-AKI.

参考文献/References:

[1] LI Yanqin, XIONG Mengqi, YANG Minliang, et al. Proton pump inhibitors and the risk of hospitalacquired acute kidney injury in children [J]. Annals of Translational Medicine, 2020, 8(21): 1438.
[2] 刘爱英.200 例医院获得性急性肾损伤病例临床分析[J]. 国际泌尿系统杂志, 2014, 34(2):186-189. LIU Aiying. Clinical analysis in 200 cases with hospital acquired acute renal injury [J]. International Journal of Urology and Nephrology, 2014, 34(2):186-189.
[3] 张珍, 王新庄. 脓毒症患者血清YKL-40 水平检测与急性肾损伤早期诊断的相关性研究[J]. 现代检验医学杂志, 2021, 36(3):148-150. ZHANG Zhen, WANG Xinzhuang. Correlation between serum YKL-40 level and early diagnosis of acute kidney injury in patients with sepsis [J]. Journal of Modern Laboratory Medicine, 2021, 36(3):148-150.
[4] MARTIN-CLEARY C, MOLINERO-CASARES L M,ORTIZ A, et al. Development and internal validation of a prediction model for hospital-acquired acute kidney injury[J]. Clinical Kidney Journal, 2021, 14(1): 309-316.
[5] 张席军, 安文军. 中期因子及CTGF 与糖尿病肾病患者纤维化相关因子关系探讨[J]. 昆明医科大学学报, 2015, 36(4):61-63. ZHANG Xijun, AN Wenjun. Relationship of midkine and CTGF to diabetic nephropathy associated fibrosis factors [J]. Journal of Kunming Medical University,2015, 36(4):61-63.
[6] 郭楚楚, 夏薇薇, 张爱华. 硫酸吲哚酚在终末期肾病心血管并发症中的研究进展[J]. 生理学报, 2018,70(6):657-662. GUO Chuchu, XIA Weiwei, ZHANG Aihua. Research progress of the uremic toxin indoxyl sulfate in cardiovascular complication of end-stage renal diseases[J]. Acta Physiologica Sinica, 2018, 70(6):657-662.
[7] 张文, 陈楠. 医院获得性急性肾损伤[J]. 中国血液净化, 2009, 8(3):127-129. ZHANG Wen, CHEN Nan. Hospital-acquired acute kidney injury[J]. Chinese Journal of Blood Purification,2009, 8(3):127-129.
[8] PALEVSKY P M, LIU K D, BROPHY P D, et al.KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J]. American Journal of Kidney Diseases, 2013, 61(5): 649-672.
[9] LIU Chen, YAN Suying, WANG Yuqin, et al. Druginduced hospital-acquired acute kidney injury in China: a multicenter cross-sectional survey[J]. Kidney Diseases (Basel, Switzerland), 2021, 7(2): 143-155.
[10] 姚兰, 杨华昱, 陈海平. 住院死亡患者发生医院获得性急性肾损伤的影响因素[J]. 中国全科医学, 2018,21(34)：4232-4236. YAO Lan, YANG Huayu, CHEN Haiping. Risk factors for hospital-acquired acute kidney injury in patients died during hospitalization [J]. Chinese General Practice,2018,21(34):4232-4236.
[11] 连兴基, 陈源汉, 林洁珊, 等. 老年人医院获得性急性肾损伤的临床特点及用药分析[J]. 中华老年多器官疾病杂志, 2018, 17(12): 901-905. LIAN Xingji, CHEN Yuanhan, LIN Jieshan, et al.Clinical characteristics and medications for hospitalacquired acute kidney injury in the elderly patients[J]. Chinese Journal of Multiple Organ Diseases in the Elderly,2018,17(12):901-905.
[12] AYNACIO?LU A ?, BILIR A, TUNA M Y. Involvement of midkine in autoimmune and autoinflammatory diseases[J]. Modern Rheumatology, 2019, 29(4): 567-571.
[13] 邓堂, 黄琪锋, 李丽华, 等. 中期因子在相关疾病发病机制和治疗中的研究进展[J]. 现代生物医学进展,2020,20(3):596-600. DENG Tang, HUANG Qifeng, LI Lihua, et al.Research progress of midkine in the related diseases pathogenesis and treatment [J]. Progress in Modern Biomedicine,2020,20(3):596-600.
[14] 白运焕, 杨媛媛, 蒋亚芬, 等. 慢性肾病患者血硫酸吲哚酚浓度与心血管疾病相关指标的关系分析[J].中华全科医学, 2016, 14(7): 1141-1143. BAI Yunhuan, YANG Yuanyuan, JIANG Yafen, et al. Relationship between serum indoxyl sulfate level and indices associated with cardiovascular disease in patients with chronic kidney disease [J]. Chinese Journal of General Practice, 2016, 14(7):1141-1143.
[15] WANG J, LEWIS J R, BYRNES E, et al. Serum midkine, estimated glomerular filtration rate and chronic kidney disease-related events in elderly women: Perth Longitudinal Study of Aging Women [J].Scientific Reports, 2020, 10(1): 14499.
[16] 王腾春, 肖永双, 温儒民, 等. 血清中期因子在肾癌患者外周血中的表达及其临床意义[J]. 国际泌尿系统杂志, 2018, 38(4):540-543. WANG Tengchun, XIAO Yongshuang, WEN Rumin,et al. Expression and clinical significance of peripheral blood midkine in patients with renal carcinoma [J].International Journal of Urology and Nephrology, 2018,38(4):540-543.
[17] MASUDA T, MAEDA K, SATO W, et al. Growth factor midkine promotes T-cell activation through nuclear factor of activated T cells signaling and Th1 cell differentiation in lupus nephritis[J]. the American Journal of Pathology, 2017, 187(4): 740-751.
[18] 祝雪妍. 中期因子在肾脏疾病中的研究进展[J]. 国际儿科学杂志, 2021, 48(1):60-63. ZHU Xueyan. Progress of midkine in kidney disease [J].International Journal of Pediatrics, 2021, 48(1):60-63.
[19] WANG S C, LAI Y H, LIU C H, et al. Association between serum indoxyl sulfate levels with carotidfemoral pulse wave velocity in patients with chronic kidney disease [J]. Renal Failure, 2021, 43(1): 796-802.
[20] COSOLA C, ROCCHETTI M T, DI BARI I, et al.An innovative synbiotic formulation decreases free serum indoxyl sulfate,small intestine permeability and ameliorates gastrointestinal symptoms in a randomized pilot trial in stage IIIb-IV CKD patients[J]. Toxins,2021, 13(5): 334.
[21] L? Jing, CHEN Jin, WANG Minjia, et al. Klotho alleviates indoxyl sulfate-induced heart failure and kidney damage by promoting M2 macrophage polarization [J]. Aging, 2020, 12(10): 9139-9150.
[22] 张晶晶, 张锦, 郑笑, 等. 住院患者社区获得性与医院获得性急性肾损伤临床特征及预后分析[J]. 中华实用诊断与治疗杂志, 2019, 33(9)：879-882. ZHANG Jingjing, ZHANG Jin, ZHENG Xiao. Clinical characteristics and prognosis of community-acquired and hospital-acquired acute kidney injury [J]. Journal of Chinese Practical Diagnosis and Therapy, 2019,33(9):879-882.
[23] 谯铭铭, 王顺, 李财昌, 等. 社区获得性与医院获得性急性肾损伤的临床特点和预后分析[J]. 中华肾脏病杂志, 2016, 32(1):16-23. QIAO Mingming, WANG Shun, LI Caichang, et al.Clinical characteristics and prognosis of communityacquired and hospital-acquired acutekidney injury [J].Chinese Journal of Nephrology, 2016, 32(1):16-23.
[24] 史忠. 重视ICU 患者医院获得性急性肾损伤[J]. 重庆医学, 2018, 47(29):3725-3729. SHI Zhong. Pay attention to hospital-acquired acute kidney injury in ICU patients[J]. Chongqing Medicine,2018, 47(29):3725-3729.
[25] 王彦娥, 丁伶清, 宋洪涛, 等. 非ICU 患者肾毒性药物与急性肾损伤关系的病例对照研究[J]. 中国医院药学杂志, 2018, 38(8):869-873. WANG Yan’e, DING Lingqing, SONG Hongtao, et al.Relationship of acute kidney injury and nephrotoxic medication exposure in non-ICU patients:a case-control study [J]. Chinese Journal of Hospital Pharmacy, 2018,38(8):869-873.
[26] 李青霖, 李淑慧, 刘旭利, 等. 高龄男性住院患者机械通气后并发急性肾损伤危险因素分析[J]. 中华肾病研究电子杂志,2017,6(5):214-218. LI Qinglin, LI Shuhui, LIU Xuli, et al. Analysis for risk factors of acute kidney injury complicated after mechanical ventilation in very elderly male inpatients [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition),2017,6(5):214-218.

备注/Memo

备注/Memo:
基金项目：武汉市医学科研项目（编号：WX19D33）。
作者介绍：刘淼（1986-），男，硕士研究生，副主任技师，研究方向：检验、诊断，E-mail：lm1986hua@163.com。
通讯作者：张黎（1970-），女，本科，副主任医师，研究方向：肾病病理，E-mail：279825428@qq.com。
更新日期/Last Update: 1900-01-01