摘要目的:探讨降钙素原(PCT)联合尿中性粒细胞明胶酶相关载脂蛋白(NGAL)对脓毒症并发急性肾损伤的预测价值。方法:回顾性选取2018年10月至2022年10月本院收治的205例脓毒症患者，依据急性肾损伤情况分为急性肾损伤组(100例)和非急性肾损伤组(105例)。统计分析两组患者的性别、年龄、急性生理与慢性健康评分(APACHE Ⅱ)、序贯器官衰竭评分(SOFA)、平均动脉压(MAP)、动脉血乳酸、白细胞计数(WBC)、血管活性药物应用情况、肾脏替代治疗情况、机械通气情况、感染性休克发生情况、ICU住院时间等一般资料；收集并分析两组患者入重症监护病房(ICU)时的尿量、血肌酐、β2微球蛋白、胱抑素C、尿素氮、尿蛋白、氨基末端脑钠肽前体(NT-proBNP)、NGAL、PCT等肾脏相关指标水平。采用单因素与多因素logistic回归分析脓毒症并发急性肾损伤的影响因素。结果:急性肾损伤组患者的APACHE Ⅱ评分、SOFA评分、动脉血乳酸水平、肾脏替代治疗接受率、感染性休克发生率、血肌酐、尿素氮、胱抑素C、β2微球蛋白、NT-proBNP、NGAL、PCT水平均高于非急性肾损伤组，尿量少于非急性肾损伤组(均 P<0.05)，尿蛋白+、+－比率均低于非急性肾损伤组，尿蛋白+、++、+++比率均高于非急性肾损伤组(均 P<0.05)。单因素分析结果显示，两组患者的血肌酐、尿素氮、胱抑素C、β2微球蛋白、NT-proBNP、尿蛋白、NGAL、PCT比较，差异均有统计学意义(均 P<0.05)。多因素logistic回归分析显示，胱抑素C、NT-proBNP、NGAL均是脓毒症并发急性肾损伤的影响因素(均 P<0.05)，血肌酐、尿素氮、β2微球蛋白、尿蛋白、PCT均不是脓毒症并发急性肾损伤的影响因素(均 P>0.05)。 结论:PCT联合NGAL对脓毒症并发急性肾损伤预测中PCT联合NGAL的价值较高。

abstractsObjective:To investigate the value of procalcitonin(PCT) combined with urinary neutrophil gelatinase-associated apolipoprotein(NGAL) in the prediction of acute kidney injury in sepsis.Methods:A total of 205 patients with sepsis admitted to our hospital from October 2018 to October 2022 were retrospectively selected and divided into acute kidney injury group (100 cases) and non-acute kidney injury group (105 cases) according to acute kidney injury. Gender, age, acute physiological and chronic health scores were statistically analyzed in both groups (APACHE Ⅱ), sequential organ failure score (SOFA), mean arterial pressure (MAP), arterial lactate, white blood cell count (WBC), use of vasoactive drugs, renal replacement therapy, mechanical ventilation, occurrence of septic shock, length of ICU stay and other general clinical data. Urinary volume, serum creatinine, β2 microglobulin, cystatin C, urea nitrogen, urinary protein, amino-terminal brain natriuretic peptide precursor (NT-proBNP), NGAL, PCT and other renal related indexes of the two groups were collected and analyzed at ICU. The influencing factors of acute kidney injury in sepsis were analyzed by univariate and multivariate logistic regression.Results:The levels of APACHE Ⅱ score, SOFA score, arterial lactate level, acceptance rate of renal replacement therapy, incidence of septic shock, serum creatinine, urea nitrogen, cystatin C, β2 microglobulin, NT-proBNP, NGAL and PCT in acute renal injury group were higher than those in non-acute renal injury group (all P<0.05). Urinary volume was lower than that in non-acute renal injury group ( P<0.05), the ratios of urinary protein + and + - were lower than those in non-acute renal injury group, and the ratios of urinary protein + , + + and + + + were higher than those in non-acute renal injury group (all P<0.05). The results of univariate analysis showed that there were statistically significant differences in serum creatinine, urea nitrogen, cystatin C, β2 microglobulin, NT-proBNP, urinary protein, NGAL and PCT between two groups (all P<0.05). Multivariate logistic regression analysis showed that cystatin C, NT-proBNP and NGAL were the influencing factors of acute renal injury in sepsis (all P<0.05), while serum creatinine, urea nitrogen, β2 microglobulin, urinary protein and PCT were not the influencing factors of acute renal injury in sepsis (all P>0.05). Conclusions:The value of PCT combined with NGAL is high in the prediction of acute kidney injury in sepsis.