| 摘要: |
| ［摘要］ 目的 分析褪黑素与降钙素原比值（MLT/PCT）对脓毒症患者急性肾损伤（AKI）发生风险的预测价值及与短期生存预后的关联性。方法 招募2021年1月至2023年12月重庆市江津区第二人民医院收治的110例脓毒症患者。根据AKI发生情况将患者分为AKI组（49例）和非AKI组（61例）。根据患者28 d内的生存情况将其分为存活组（74例）和死亡组（36例）。于患者入院后次日采用电化学发光免疫分析法检测血清降钙素原（PCT）水平，采用酶联免疫吸附试验（ELISA）检测血清褪黑素（MLT）水平，计算MLT/PCT。采用多因素logistic回归分析脓毒症患者发生AKI的影响因素。通过受试者工作特征（ROC）曲线分析MLT、PCT和MLT/PCT对脓毒症患者发生AKI的预测效能。采用Kaplan-Meier法分析MLT/PCT与患者生存预后的关联性。结果 AKI组年龄大于非AKI组，APACHEⅡ评分、高血压比例、白细胞计数、中性粒细胞百分比、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、血肌酐、尿素氮、血乳酸和PCT水平高于非AKI组，淋巴细胞百分比、红细胞计数、血小板计数、血pH、MLT水平和MLT/PCT低于非AKI组，差异有统计学意义（P<0.05）。ROC曲线分析结果显示，MLT/PCT预测脓毒症患者发生AKI的效能［AUC（95%CI）=0.920（0.853～0.963）］优于MLT和PCT（P<0.05），灵敏度为93.92%，特异度为75.38%。多因素logistic回归分析结果显示，较高的MLT/PCT是脓毒症患者发生AKI的独立保护因素（P<0.05）。存活组MLT水平、MLT/PCT显著高于死亡组（P<0.05）。高MLT/PCT组（≥3.3，55例）生存预后优于低MLT/PCT组（<3.3，55例）（log-rank检验： χ2=23.627，P<0.001）。结论 MLT/PCT可作为预测脓毒症患者AKI发生风险的指标，且与脓毒症患者短期生存预后有关。 |
| 关键词: 脓毒症 急性肾损伤 褪黑素 降钙素原 预后 |
| DOI：10.3969/j.issn.1674-3806.2025.02.15 |
| 分类号:R 459.7 |
| 基金项目:重庆市江津区科技计划项目（编号：Y2022048） |
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| The value of melatonin-to-procalcitonin ratio in predicting the risk of acute kidney injury and its association with short-term survival in sepsis patients |
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YUAN Yuan, HUANG Peiyong, LIU Shulin, YUAN Yuting
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Department of Critical Care Medicine, Chongqin Jiangjin Second People′s Hospital, Chongqing 402289, China
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| Abstract: |
| ［Abstract］ Objective To analyze the value of melatonin-to-procalcitonin ratio(MLT/PCT) in predicting the risk of acute kidney injury(AKI) and its association with short-term survival in sepsis patients. Methods A total of 110 patients with sepsis who were admitted to Chongqin Jiangjin Second People′s Hospital from January 2021 to December 2023 were recruited. The patients were divided into AKI group(49 cases) and non-AKI group(61 cases) according to the occurrence of AKI. The patients were divided into survival group(74 cases) and death group(36 cases) according to their survival status within 28 days. On the second day after admission, the serum procalcitonin(PCT) levels were detected by using electrochemiluminescence immunoassay, and the serum melatonin(MLT) levels were detected by using enzyme-linked immunosorbent assay(ELISA), and MLT/PCT was calculated. Multivariate logistic regression was used to analyze the influencing factors of AKI in patients with sepsis. The predictive efficacy of MLT, PCT and MLT/PCT for AKI in the patients with sepsis was analyzed by using receiver operating characteristic(ROC) curve. Kaplan-Meier method was used to analyze the association between MLT/PCT and the patients′ survival prognosis. Results The patients in the AKI group were older than those in the non-AKI group, and the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores, proportion of hypertensive patients, white blood cell count, neutrophil percentage, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine, urea nitrogen, blood lactate and PCT levels in the AKI group were higher than those in the non-AKI group, and the percentage of lymphocytes, red blood cell count, platelet count, blood pH, MLT levels and MLT/PCT in the AKI group were lower than those in the non-AKI group, and the differences were statistically significant(P<0.05). The results of ROC curve analysis showed that MLT/PCT［AUC(95%CI)=0.920(0.853-0.963)］ was superior to MLT and PCT(P<0.05) in predicting AKI occurrence in the sepsis patients, with sensitivity of 93.92% and specificity of 75.38%. The results of multivariate logistic regression analysis showed that higher MLT/PCT was an independent protective factor for AKI in sepsis patients(P<0.05). The MLT levels and MLT/PCT in the survival group were significantly higher than those in the death group(P<0.05). The survival prognosis of the high MLT/PCT group(≥3.3, 55 cases) was better than that of the low MLT/PCT group(<3.3, 55 cases)(log-rank test: χ2=23.627, P<0.001). Conclusion MLT/PCT can be used as an indicator to predict the risk of AKI in sepsis patients, and MLT/PCT is associated with short-term survival prognosis of the sepsis patients. |
| Key words: Sepsis Acute kidney injury(AKI) Melatonin(MLT) Procalcitonin(PCT) Prognosis |
