2022 年第 3 期 第 17 卷

血清可溶性血栓调节蛋白及乳脂球表皮生长因子8水平与感染性休克合并急性肾损伤患者预后的相关性分析

Relationship of serum soluble thrombomodulin and milk fat globule epidermal growth factor-8 with prognosis in patients with septic shock and acute kidney injury

作者：柴海霞1刘静梅2王会军3王印华1郭炜妍1轩兴伟1王静悦4

英文作者：Chai Haixia1 Liu Jingmei2 Wang Huijun3 Wang Yinhua1 Guo Weiyan1 Xuan Xingwei1 Wang Jingyue4

单位：1华北理工大学附属医院重症医学科，唐山063000；2河北省唐山市协和医院肾内科，唐山063000；3河北省唐山南湖医院检验科，唐山063000；4华北理工大学附属医院神经内科，唐山063000

英文单位：1Department of Intensive Care Unit North China University of Science and Technology Affiliated Hospital Tangshan 063000 China; 2Department of Nephrology Tangshang Union Medical College Hospital Tangshan 063000 China; 3Department of Clinical Laboratory Tangshan Nanhu Hospital Tangshan 063000 China; 4Department of Neurology North China University of Science and Technology Affiliated Hospital Tangshan 063000 China

关键词：感染性休克；急性肾损伤；可溶性血栓调节蛋白；乳脂球表皮生长因子8

英文关键词：Septicshock;Acutekidneyinjury;Solublethrombomodulin;Milkfatglobuleepidermalgrowthfactor-8

• 摘要：

• 目的 探讨血清可溶性血栓调节蛋白（sTM）和乳脂球表皮生长因子8（MFG-E8）水平与感染性休克合并急性肾损伤（AKI）患者预后的相关性。方法  选取2019年1月至2021年4月于华北理工大学附属医院接受连续性肾脏替代治疗的60例感染性休克合并AKI患者（AKI组），另选取同期50例无AKI的感染性休克患者（非AKI组）及60例健康体检者（对照组）。检测患者治疗前、健康体检者体检时血清sTM、MFG-E8、血肌酐及血尿素氮水平。记录AKI组患者死亡情况，比较死亡与存活患者血清sTM、MFG-E8水平。分析感染性休克合并AKI患者血清sTM、MFG-E8与血肌酐和血尿素氮的相关性以及患者死亡的影响因素。结果 AKI组、非AKI组血清sTM、血肌酐、血尿素氮水平高于对照组，且AKI组均高于非AKI组；血清MFG-E8水平均低于对照组，且AKI组低于非AKI组（均P＜0.001）。AKI组血清sTM水平与血肌酐和血尿素氮水平呈正相关（r=0.510，P＜0.001；r=0.639，P＜0.001），血清MFG-E8水平与血肌酐和血尿素氮水平呈负相关（r=-0.749，P＜0.001；r=-0.758，P＜0.001）。AKI组患者死亡18例（30.0%），死亡患者血清sTM水平高于而血清MFG-E8水平低于存活患者［（44±7）kTU/L比（36±12）kTU/L、（45±9）μg/L比（77±16）μg/L］（均P＜0.001）。多因素Cox比例风险分析结果表明，血肌酐、血尿素氮、sTM是感染性休克合并AKI患者死亡的独立危险因素，MFG-E8是感染性休克合并AKI患者死亡的独立保护因素（均P＜0.05）。结论  感染性休克合并AKI患者血清sTM水平升高、MFG-E8水平降低，且与AKI严重程度和不良预后相关。

• Objective   To study the relationship of serum soluble thrombomodulin (sTM) and milk fat globule epidermal growth factor-8 (MFG-E8) levels with prognosis in patients with septic shock and acute kidney injury (AKI). Methods   From January 2019 to April 2021, 60 patients with septic shock and AKI who underwent continuous renal replacement therapy in North China University of Science and Technology Affiliated Hospital were enrolled (AKI group). Another 50 patients had septic shock without AKI (non-AKI group) and 60 healthy persons undergoing physical examination (control group) were enrolled at same period. Levels of serum sTM, MFG-E8, serum creatinine and blood urea nitrogen were detected in patients before treatment and in healthy persons when underwent physical examination. Death in AKI group was recorded, and serum levels of sTM and MFG-E8 were compared between dead and survival patients. The relationship of serum sTM, MFG-E8, serum creatinine and blood urea nitrogen was analyzed, and the influencing factors of patients death were analyzed. Results  Levels of serum sTM, serum creatinine and blood urea nitrogen in AKI group and non-AKI group were higher than those in control group, and those in AKI group were higher than those in non-AKI group; the serum level of MFG-E8 in AKI group and non-AKI group was lower than that in control group and that in AKI group was lower than that in non-AKI group (all P<0.001). In AKI group, the serum level of sTM was positively correlated with levels of serum creatinine and blood urea nitrogen (r=0.510, P＜0.001; r=0.639, P＜0.001), and the serum level of MFG-E8 was negatively correlated with levels of serum creatinine and blood urea nitrogen (r=-0.749, P＜0.001; r=-0.758, P＜0.001). Eighteen patients (30.0%) dead in AKI group; the serum level of sTM in death patients was higher than that in survival patients and the serum level of MFG-E8 in death patients was lower than that in survival patients［（44±7）kTU/L vs （36±12）kTU/L, （45±9）μg/L vs （77±16）μg/L］(both P＜0.001). Multivariate Cox proportional hazard analysis showed that serum creatinine, blood urea nitrogen and sTM were independent risk factors of death in patients with septic shock and AKI, and MFG-E8 was an independent protective factor (all P<0.05). Conclusion The serum level of sTM increases and the level of MFG-E8 decreases in patients with septic shock and AKI, which are related to the severity of AKI and poor prognosis.