摘要
目的探讨血浆成纤维细胞生长因子23(FGF23)、血管生成素2(Ang2)水平对急性呼吸窘迫综合征(ARDS)患者并发急性肾损伤(AKI)的预测价值。方法选择2018年9月—2020年10月成都市第三人民医院收治ARDS患者210例,其中合并AKI 86例(AKI组),未合并AKI 124例(NAKI组)。检测患者血浆FGF23、Ang2水平,Pearson相关或Spearman秩相关分析血浆FGF23、Ang2与AKI分期及肾功能相关性,Logistic回归分析ARDS并发AKI的危险因素,受试者工作特征曲线(ROC)分析血浆FGF23、Ang2预测ARDS患者并发AKI的价值。结果AKI组血浆FGF23、Ang2水平高于NAKI组(t/P=25.182/0.000、10.331/0.000),AKI 3~5期亚组患者血浆FGF23、Ang2水平高于AKI 1~2期亚组(t/P=36.032/0.000、46.870/0.000)。血浆FGF23、Ang2水平与AKI分期、尿素氮(BUN)、血肌酐(SCr)、胱抑素C(CysC)水平呈正相关(FGF23:r/P=0.639/0.000、0.515/0.005、0.603/0.000、0.534/0.002;Ang2:r/P=0.647/0.000、0.521/0.005、0.657/0.000、0.559/0.000),与肾小球滤过率(eGFR)水平呈负相关(r/P=-0.705/0.000、-0.683/0.000)。Logistic回归分析显示,高血压、ARDS分级重度及高水平FGF23、Ang2是ARDS并发AKI的危险因素[OR(95%CI)=1.702(1.652~1.832)、1.828(1.765~1.943)、1.790(1.653~1.837)、1.824(1.718~1.936)]。ROC分析显示,血浆FGF23联合Ang2预测ARDS患者并发AKI的AUC为0.934,高于单独FGF23和Ang2检测的0.709、0.771(Z/P=2.698/0.002、2.302/0.009)。结论血浆FGF23、Ang2水平升高与ARDS并发AKI密切相关,可作为肾损伤的预测指标,联合血浆FGF23和Ang2可提高诊断AKI的效能。
Objective To explore the predictive value of plasma fibroblast growth factor 23(FGF23)and angiopoietin 2(Ang2)levels in patients with acute respiratory distress syndrome(ARDS)complicated by acute kidney injury(AKI).Methods From September 2018 to October 2020,Chengdu Third People's Hospital was selected to treat 210 patients with ARDS,including 86 cases with AKI(AKI group)and 124 cases without AKI(NAKI group).Detect plasma FGF23 and Ang2 levels in patients,Pearson correlation or Spearman rank correlation analysis of plasma FGF23,Ang2 and AKI staging and renal function correlation,Logistic regression analysis of risk factors for ARDS complicated with AKI,receiver operating characteristic curve(ROC)analysis of plasma FGF23,Ang2 predicts the value of AKI in patients with ARDS.Results The plasma FGF23 and Ang2 levels in the AKI group were higher than those in the NAKI group(t/P=25.182/0.000,10.331/0.000).The plasma FGF23 and Ang2 levels in the AKI subgroups 3 to 5 were higher than those in the AKI subgroups 1 to 2(t/P=36.032/0.000,46.870/0.000).Plasma FGF23 and Ang2 levels are positively correlated with AKI staging,urea nitrogen(BUN),blood creatinine(SCr),and cystatin C(CysC)levels(FGF23:r/P=0.639/0.000,0.515/0.005,0.603/0.000,0.534/0.002;Ang2:r/P=0.647/0.000,0.521/0.005,0.657/0.000,0.559/0.000),which is negatively correlated with the glomerular filtration rate(eGFR)level(r/P=-0.705/0.000,-0.683/0.000).Logistic regression analysis showed that hypertension,ARDS scores,high levels of FGF23 and Ang2 were risk factors for ARDS complicated with AKI[OR(95%CI)=1.702(1.652-1.832),1.828(1.765-1.943),1.790(1.653-1.837),1.824(1.718-1.936)].ROC analysis showed that the AUC of plasma FGF23 combined with Ang2 to predict ARDS patients with AKI was 0.934,were higher than 0.709 and 0.771 detected by FGF23 and Ang2 alone(Z/P=2.698/0.002,2.302/0.009).Conclusion The increase of plasma FGF23 and Ang2 levels is closely related to ARDS complicated by AKI,and can be used as a predictor of kidney injury.Combining plasma FGF23 and Ang2 can improve the diagnostic efficiency of AKI.
作者
徐慈
李亚茜
项涛
谷纯伟
童同
Xu Ci;Li Yaqian;Xiang Tao;Gu Chunwei;Tong Tong(Emergency Department, Chengdu Third People's Hospital, Sichuan Province,Chengdu 610000,China)
出处
《疑难病杂志》
CAS
2021年第11期1126-1130,共5页
Chinese Journal of Difficult and Complicated Cases
基金
四川省卫生计生委科研项目(18ZD038)。
