2023 年第 3 期 第 18 卷

脓毒症患者血浆晚期糖基化终末产物和可溶性糖基化终末产物受体水平变化及其与并发急性肾损伤的相关性

Changes of plasma levels of advanced glycation end products and soluble receptor for advanced glycation end products in patients with sepsis and their correlation with acute kidney injury

作者：黎金国何书典邢柏

英文作者：Li Jinguo He Shudian Xing Bo

单位：海南医学院第二附属医院重症监护室，海口570311

英文单位：Department of Intensive Care Unit the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：脓毒症；急性肾损伤；晚期糖基化终末产物；可溶性糖基化终末产物受体

英文关键词：Sepsis；Acutekidneyinjury；Advancedglycationendproducts；Solublereceptorforadvancedglycationendproducts

• 摘要：

• 目的 探讨脓毒症患者血浆晚期糖基化终末产物（AGEs）和可溶性糖基化终末产物受体（sRAGE）水平变化及其与并发急性肾损伤（AKI）的相关性。方法 选择2021年1月至2022年6月海南医学院第二附属医院重症监护病房收治的脓毒症患者180例作为脓毒症组，根据入院后1周内是否发生AKI分为AKI组（106例）和非AKI组（74例）；另选取同期在本院体检的年龄、性别匹配的健康者50例为对照组。收集受试者的一般资料，计算脓毒症患者入院后24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估（SOFA）评分、查尔森共病指数评分，检测脓毒症患者的炎性指标如降钙素原、C反应蛋白（CRP）、血乳酸以及受试者的血浆AGEs、sRAGE水平。比较各组研究对象临床特征的差异，分析脓毒症患者并发AKI的危险因素。采用受试者工作特征（ROC）曲线分析血浆AGEs、sRAGE对脓毒症患者并发AKI的预测价值。结果 脓毒症组血浆AGEs和sRAGE水平明显高于对照组［18.8（13.3,29.7）mg/L比11.9（9.2,15.6）mg/L、1 348.1（792.9,2 477.5）ng/L比324.3（276.7,421.4）ng/L］，差异均有统计学意义（均P＜0.001）。AKI组患者入院后24 h内APACHE Ⅱ评分、SOFA评分、应用血管活性药物治疗比例、血清降钙素原、CRP、血乳酸、血浆AGEs、sRAGE水平及28 d病死率均高于非AKI组，差异均有统计学意义（均P＜0.05）。多因素Logistic 回归分析结果显示，高SOFA评分、应用血管活性药物以及血清降钙素原、AGEs和sRAGE水平升高是脓毒症患者并发AKI的独立危险因素（均P＜0.05）。ROC曲线分析结果显示，血浆AGEs、sRAGE预测脓毒症患者并发AKI的曲线下面积（AUC）分别为0.719、0.813。二者联合检测时AUC为0.901，明显大于单一指标检测时的AUC（均P＜0.001）。结论 脓毒症患者血浆AGEs、sRAGE水平显著上调，并与并发AKI密切相关，二者均可作为有效预测脓毒症患者并发AKI的生物标志物。

• Objective  To explore the changes of plasma levels of advanced glycation end products(AGEs) and soluble receptor for advanced glycation end products(sRAGE) in patients with sepsis and their correlation with acute kidney injury(AKI). Methods  A total of 180 patients with sepsis admitted to Department of Intensive Care Unit, the Second Affiliated Hospital of Hainan Medical University from January 2021 to June 2022 were selected as the sepsis group. According to the occurrence of AKI within 1 week after admission, patients were divided into AKI group(106 cases) and non-AKI group(74 cases). In addition， 50 healthy people who were examined in the hospital during the same period were selected as the control group. The general data of subjects were collected, and the acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, Charlson comorbidity index score of patients with sepsis were calculated within 24 h after admission. The inflammatory indexes of the patients with sepsis such as procalcitonin (PCT), C-reactive protein (CRP), blood lactate, plasma levels of AGEs and sRAGE of the subjects were detected. The clinical characteristics of objects in each group were compared. The risk factors of AKI in patients with sepsis were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of plasma AGEs and sRAGE for AKI in patients with sepsis. Results  The plasma levels of AGEs and sRAGE in the sepsis group were significantly higher than those in the control group［18.8（13.3,29.7）mg/L vs 11.9（9.2,15.6）mg/L, 1 348.1（792.9,2 477.5）ng/L vs 324.3（276.7,421.4）ng/L］(both P＜0.05). The APACHE Ⅱ score, SOFA score, the proportion of requiring vasoactive agent treatment, and levels of PCT, CRP, blood lactate, plasma AGEs and sRAGE in the AKI group within 24 h after admission were significantly higher than those in the non-AKI group(all P＜0.05). Multivariate Logistic regression analysis showed that high SOFA score, requiring vasoactive agent treatment, and elevated levels of PCT, AGEs and sRAGE were independent risk factors for AKI in patients with sepsis(all P＜0.05). ROC curve analysis showed that the areas under the curve (AUC) of plasma AGEs and sRAGE were 0.719 and 0.813, respectively, in predicting AKI in patients with sepsis. AUC of AGEs combined with sRAGE was 0.901, which was larger than the two alone (both P<0.001). Conclusions  The plasma levels of AGEs and sRAGE in patients with sepsis are significantly up-regulated, and closely related to AKI. The combined detection of the two factors can be used as biomarkers to effectively predict AKI in patients with sepsis.