降钙素原检测在脓毒血症急性肾损伤中的意义

1 资料与方法

1.1 一般资料收集2013年1～10月入住本院脓毒血症患者50例为实验组, 再将其分为AKI阳性组(8例)和AKI阴性组(42例), 男32例, 女18例, 年龄42～94岁；对照组为本院健康体检者, 男30例, 女20例, 年龄46～90岁。实验组和对照组性别、年龄比较差异无统计学意义(P＞0.05), 具有可比性。脓毒血症诊断标准依据2007年中华医学会急诊分会危重病专家委员会制定。AKI诊断标准：48 h内Scr上升≥26.5 μmol/L, 或较原Scr值增长≥50%和(或)尿量＜0.5 ml/(kg·h)达6 h以上。

1.2 标本采集患者入院后第2天早晨, 空腹采集静脉血, 4 ml置于促凝管, 3000 r/min离心10 min检测PCT和CRP；2 ml置于EDTA-K2抗凝管检测WBC。

1.3 检测方法 PCT用化学发光免疫夹心法在MAGLUMI化学发光测定仪上检测；CRP采用免疫散射比浊法在DAD EBEHRING BNP血浆蛋白分析系统上检测；WBC采用半导体激光流式细胞术法在SYSMEX XS-800I仪器上检测。

1.4 统计学方法采用SPSS17.0统计软件对数据进行统计分析。计量资料以均数 ± 标准差( x-±s)表示, 采用t检验；计数资料以率(%)表示, 采用χ2检验。P＜0.05表示差异具有统计学意义。

2 结果

2.1 实验组与对照组检测结果比较, 见表1。

2.2 AKI阳性组与AKI阴性组检测结果比较, 见表2。

表1 实验组与对照组PCT、CRP、WBC检测结果比较( x-±s)

表2 AKI阳性组与AKI阴性组PCT、CRP、WBC检测结果比较( x-±s)

3 讨论

脓毒血症是感染引起的全身炎症综合征, 能引起严重并发症如多器官衰竭［2］。AKI是肾小球滤过率突然持续下降,导致含氮和非含氮代谢物蓄积引起的一种综合征。脓毒血症AKI死亡率高达74.5%, 明显高于单纯AKI(45.2%), 呈现升高趋势［3］。

PCT被证实在识别细菌感染、感染严重程度及脓毒血症方面是一个早期敏感指标, 可以作为脓毒血症诱导急性肾损伤患者的预测指标［4］。CRP是在病理状态下由肝脏合成并分泌的急性期反应蛋白, 除病毒感染外, 细菌感染、循环系统疾病及创伤等均可导致其升高［5］。在本研究中, 脓毒血症患者体内PCT、CRP、WBC均明显高于正常对照组。AKI阳性组PCT较AKI阴性组明显增高, CRP、WBC检测结果两组差异无统计学意义(P＞0.05)。脓毒血症和感染性休克是重症患者引起AKI的最主要原因, 有50%以上AKI病例发生在ICU, 且死亡率极高［6］。因此, 快速识别脓毒血症导致急性肾损伤至关重要。相对细菌培养, PCT检测时间明显缩短。临床上可以根据PCT检测结果, 对脓毒血症患者指导抗生素应用, 从而防止AKI的发生。

［1］ Ishani A, Xue JL, Himmelfarb J, et al.Acute kidney injury increases risk of ESRD among elderly.J Am Soc Nephrol, 2009, 20 (1):223-228.［2］ Bone RC, Sprung CL, Sibbald WJ.Definitions for sepsis and organ failure.Crit Care Med , 1992, 20(6):724-726.

［3］ Klenzak J, Himmelfarb J.Sepsis and the kidney.Crit Care Clin, 2005, 21(2):211-222.

［4］ Nie X, Wu B, He Y, et al.Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection.Clin Chem Lab Med, 2013, 51(8):1655-1661.

［5］ Christ-Crain M, Opal SM.Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia.Crit Care, 2010, 14(1):203.

［6］ Uchino S, Kellum JA, Bellomo R, et al.Acute renal failure in critically ill patients: a multinational, multicenter study.JAMA, 2005, 294(7):813-818.

Significance of procalcitonin detection in septicopyemia induced acute kidney injury

XIN Xiao-ni, LI Li, YUAN Jiang-shui, et al.Department of Inspection, Qingdao Municipal Hospital, Qingdao 266011, China

Objective To investigate the guidance value of procalcitonin (PCT) detection in septicopyemia induced acute kidney injury (AKI).Methods There were 50 septicopyemia patients as the experimental group, and they were divided into AKI positive group (8 cases) and AKI negative group (42 cases).There were also 50 healthy people as the control group.Detections were made on levels of PCT, C-reactive protein (CRP), and white blood cell (WBC).Results The experimental group had increased levels of PCT, CRP, and WBC than the control group, and the difference had statistical significance (P＜0.05).The AKI positive group had more obvious increase than the AKI negative group, and the difference had statistical significance (P＜0.05).The difference of CRP and WBC was not statistically significant (P＞0.05).Conclusion Concentration of PCT is more sensitive than CRP and WBC in patients of septicopyemia induced acute kidney injury, and that can be used to assess the risk of S-AKI.

Procalcitonin; Septicopyemia; Acute kidney injury; C-reactive protei

2014-11-14］

266011 青岛市市立医院检验科

李莉

10.14163/j.cnki.11-5547/r.2015.09.018