中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2012年
2期
124-127
,共4页
脓毒症%半胱氨酸蛋白酶抑制剂C%β2微球蛋白%急性生理与慢性健康状况评分Ⅱ
膿毒癥%半胱氨痠蛋白酶抑製劑C%β2微毬蛋白%急性生理與慢性健康狀況評分Ⅱ
농독증%반광안산단백매억제제C%β2미구단백%급성생리여만성건강상황평분Ⅱ
Sepsis%Cysteine proteinase inhibitors C%beta 2-Microglobulin%Acute physiology and chronic health evaluation Ⅱ score
目的 探讨半胱氨酸蛋白酶抑制剂C (Cys-C)和β2微球蛋白(β2MG)对脓毒症急性肾损伤的早期诊断价值,Cys-C与急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)的相关性及预后的价值.方法 选取自2008年10月至2009年10月在北京朝阳医院急诊抢救室收治的脓毒症患者250例,来院时分别测定血清肌酐(SCr)、β2MG、Cys-C,计算APACHEⅡ评分,并观察28 d死亡率,其中发生急性肾损伤者63例,未发生急性肾损伤187例.利用受试者工作特征曲线(ROC)下面积、Cys-C与β2MG预测急性肾损伤发生的准确性,并探讨在脓毒症急性肾损伤中Cys-C水平改变与APACHEⅡ评分的关系.结果 急性肾损伤组Cys-C、β2MG浓度均高于非急性肾损伤组[分别为(1189 ±214) μg/Lvs.(678±118) μg/L,P=0.007;( 3705±599) μg/Lvs.(2365±446) μg/L,P=0.004].急性肾损伤组SCr浓度、APACHEⅡ评分高于非急性肾损伤组[分别为(145 ±49)分vs.(73±25)分,P=0.013；(19±4)分vs.(13±4)分,P=0.016].急性肾损伤组患者Cys-C与APACHEⅡ评分有良好相关性(P＜0.01).急性肾损伤组28 d死亡率高于非急性肾损伤组(P＜0.01).Cys-C(OR=1.006,95％ CI=1.002 ～1.009),ROC下面积是0.909；血β2MG( OR=1.001,95％ CI=1.000～ 1.001),ROC下面积是0.820.结论 监测血清Cys-C和血β2MG浓度可有效预测脓毒症患者发生急性肾损伤；与β2MG相比,Cys-C预测急性肾损伤的准确性较高,并提示预后不良.
目的 探討半胱氨痠蛋白酶抑製劑C (Cys-C)和β2微毬蛋白(β2MG)對膿毒癥急性腎損傷的早期診斷價值,Cys-C與急性生理與慢性健康狀況評分Ⅱ(APACHEⅡ)的相關性及預後的價值.方法 選取自2008年10月至2009年10月在北京朝暘醫院急診搶救室收治的膿毒癥患者250例,來院時分彆測定血清肌酐(SCr)、β2MG、Cys-C,計算APACHEⅡ評分,併觀察28 d死亡率,其中髮生急性腎損傷者63例,未髮生急性腎損傷187例.利用受試者工作特徵麯線(ROC)下麵積、Cys-C與β2MG預測急性腎損傷髮生的準確性,併探討在膿毒癥急性腎損傷中Cys-C水平改變與APACHEⅡ評分的關繫.結果 急性腎損傷組Cys-C、β2MG濃度均高于非急性腎損傷組[分彆為(1189 ±214) μg/Lvs.(678±118) μg/L,P=0.007;( 3705±599) μg/Lvs.(2365±446) μg/L,P=0.004].急性腎損傷組SCr濃度、APACHEⅡ評分高于非急性腎損傷組[分彆為(145 ±49)分vs.(73±25)分,P=0.013；(19±4)分vs.(13±4)分,P=0.016].急性腎損傷組患者Cys-C與APACHEⅡ評分有良好相關性(P＜0.01).急性腎損傷組28 d死亡率高于非急性腎損傷組(P＜0.01).Cys-C(OR=1.006,95％ CI=1.002 ～1.009),ROC下麵積是0.909；血β2MG( OR=1.001,95％ CI=1.000～ 1.001),ROC下麵積是0.820.結論 鑑測血清Cys-C和血β2MG濃度可有效預測膿毒癥患者髮生急性腎損傷；與β2MG相比,Cys-C預測急性腎損傷的準確性較高,併提示預後不良.
목적 탐토반광안산단백매억제제C (Cys-C)화β2미구단백(β2MG)대농독증급성신손상적조기진단개치,Cys-C여급성생리여만성건강상황평분Ⅱ(APACHEⅡ)적상관성급예후적개치.방법 선취자2008년10월지2009년10월재북경조양의원급진창구실수치적농독증환자250례,래원시분별측정혈청기항(SCr)、β2MG、Cys-C,계산APACHEⅡ평분,병관찰28 d사망솔,기중발생급성신손상자63례,미발생급성신손상187례.이용수시자공작특정곡선(ROC)하면적、Cys-C여β2MG예측급성신손상발생적준학성,병탐토재농독증급성신손상중Cys-C수평개변여APACHEⅡ평분적관계.결과 급성신손상조Cys-C、β2MG농도균고우비급성신손상조[분별위(1189 ±214) μg/Lvs.(678±118) μg/L,P=0.007;( 3705±599) μg/Lvs.(2365±446) μg/L,P=0.004].급성신손상조SCr농도、APACHEⅡ평분고우비급성신손상조[분별위(145 ±49)분vs.(73±25)분,P=0.013；(19±4)분vs.(13±4)분,P=0.016].급성신손상조환자Cys-C여APACHEⅡ평분유량호상관성(P＜0.01).급성신손상조28 d사망솔고우비급성신손상조(P＜0.01).Cys-C(OR=1.006,95％ CI=1.002 ～1.009),ROC하면적시0.909；혈β2MG( OR=1.001,95％ CI=1.000～ 1.001),ROC하면적시0.820.결론 감측혈청Cys-C화혈β2MG농도가유효예측농독증환자발생급성신손상；여β2MG상비,Cys-C예측급성신손상적준학성교고,병제시예후불량.
Objective To assess the significance of serum cysteine proteinase inhibitor C (Cys-C) and β2 microglobulin (β2MG) concentrations in the diagnosis and prognosis of sepsis-induced acute kidney injury.Methods Two hundred and fifty patients presenting to the Emergency Department of Beijing Chaoyang Hospital from October 2008 to October 2009 with sepsis were assessed.Serum creatinine (SCr),β2MG and Cys-C concentrations and Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ ) scores were determined when the septic patients presented to the hospital. The 28-day mortality was recorded.The study patients were retrospectively divided into acute kidney injury ( n =63 ) and no acute kidney injury groups (n =187 ).The predictive accuracies of Cys-C and β2MG for acute kidney injury were analyzed by plotting a relative operating characteristic (ROC) curve.The Spearman interclass correlation method was used to analyze the correlation between Cys-C concentration and APACHE Ⅱ score in sepsisinduced acute kidney injury.Results Cys-C and β2 MG concentrations were significantly greater in the acute than in the no acute kidney injury group [ ( 1189 ± 214) μg/L vs.(678 ± 118) μg/L,P =0.007 ; (3705 ±599)μg/L vs.(2365 ±446) μg/L,P =0.004,respectively].SCr concentrations and APACHE Ⅱ scores were significantly greater in the acute than in the no acute kidney injury group [ (145 ±49) vs.(73 ±25),P=0.013,(19 ±4) vs.(13 ±4),P=0.016].There was a significant correlation between Cys-C concentration and APACHEII score in the acute kidney injury group (P ＜0.01).The 28-day mortality was significantly greater in the acute than in the no acute kidney injury group.The areas under the ROC curve for Cys-C and β2MG concentrations were 0.909 ( OR =1.006,95％ CI =1.002 - 1.009) and 0.82 ( OR =1.001,95％ CI =1.000 -1.001),respectively.Conclusions Monitoring of Cys-C and β2MG concentrations can effectively predict the occurrence of acute kidney injury in septic patients.Cys-C concentration is a more accurate predictor of this diagnosis than β2MG concentration.An increasing Cys-C concentration is an indicator of poor prognosis.
