血清TRAF-6、MCP-1、sTREM-1、IL-33水平与脓毒症严重程度及与合并急性肾损伤关系的临床分析

目的:探讨脓毒症患者血清肿瘤坏死因子受体相关因子(Tumor necrosis factor receptor-related factor,TRAF)-6、单核细胞趋化蛋白(Monocyte chemotactic protein,MCP)-1、可溶性髓样细胞触发受体(Soluble myeloid cell trigger receptor,s TREM)-1、白介素(Interleukin,IL)-33水平的变化及与病情严重程度及合并急性肾损伤(acute kidney injury, AKI)的相关性。方法:选择2014年2月到2018年7月在我医院ICU病房进行诊治的脓毒症患者145例,分析脓毒症相关性急性肾损伤(sepsis-associated AKI,SAKI)的发生情况,比较SAKI和非SAKI患者血清TRAF-6、MCP-1、s TREM-1、IL-33水平,采用Pearson相关分析血清TRAF-6、MCP-1、s TREM-1、IL-33含量与APACHEⅡ评分、SOFA评分的相关性,多因素logistic回归分析脓毒症患者发生SAKI的影响因素。结果:在145例患者中,发生SAKI者69例,发生率为47.6%。SAKI组患者的年龄、性别、原发病、白细胞(white blood cell,WBC)计数、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、体重指数、BUN、Scr与eGFR值与非SAKI组患者对比差异均无统计学意义(P0.05)。SAKI组患者APACHEⅡ评分、SOFA评分血清TRAF-6、MCP-1、s TREM-1、IL-33含水平含量均显著高于非SAKI组患者(P0.05)。Pearson相关性分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平与SAKI患者的急性生理和慢性健康Ⅱ(acute physiology and chronic health evaluation II,APACHEⅡ)评分、序贯多器官功能障碍(sequential organ failure assessment,SOFA)评分均呈显著正相关性(P0.05)。logistic回归分析显示血清TRAF-6、MCP-1、s TREM-1、IL-33水平升高均为影响SAKI发生的独立危险因素(P0.05)。结论:血清TRAF-6、MCP-1、s TREM-1、IL-33水平与脓毒症严重程度显著相关,可能作为诊断和治疗SAKI的参考指标及干预靶点。

Clinical Analysis of the Relationship between Serum TRAF-6, MCP-1, sTREM-1, IL-33 and Severity of Sepsis and Acute Kidney Injury

ABSTRACT Objective: To investigate the changes of tumor necrosis factor receptor-related factor (TRAF)-6, monocyte chemotactic protein (MCP)-1, soluble myeloid cell triggering receptor (sTREM)-1, interleukin (IL)-33 levels in patients with sepsis and their correlation with the severity of disease and acute kidney injury (AKI). Methods: A total of 145 patients with sepsis who were treated in the ICU ward of our hospital from February 2014 to July 2018 were enrolled. The incidence of sepsis-associated acute kidney injury (SAKI) were analyzed. SAKI were compared. Serum levels of TRAF-6, MCP-1, sTREM-1, and IL-33 in patients with non-SAKI, and Pearson correlation analysis of serum TRAF-6, MCP-1, sTREM-1, IL-33 and APACHE II scores, SOFA scores Correlation, multivariate logistic regression analysis of the influencing factors of SAKI in patients with sepsis. Results: Of the 145 patients, 69 had SAKI, an incidence of 47.6%. Age, gender, primary disease, white blood cell (WBC) count, C reactive protein (CRP), procalcitonin (PCT), body mass index, BUN, Scr and There were no significant difference between the eGFR value and the non-SAKI group (P<0.05). The APACHE II score, SOFA score, serum TRAF-6, MCP-1, sTREM-1, and IL-33 levels in the SAKI group were significantly higher than those in the non-SAKI group(P<0.05). Pearson correlation analysis showed serum TRAF-6, MCP-1, sTREM-1, IL-33 levels and acute physiology and chronic health evaluation II (APACHE II) scores in SKI patients, sequential multiple organs Sequential organ failure assessment (SOFA) scores were significantly positively correlated (P<0.05). Logistic regression analysis showed that elevated levels of serum TRAF-6, MCP-1, sTREM-1, and IL-33 were independent risk factors for SAKI (P<0.05). Conclusion: The serum TRAF-6, MCP-1, sTREM-1, and IL-33 levels were significantly associated with the severity of sepsis and may serve as references for the diagnosis and treatment of SAKI.