脓毒症病原菌及HMGB1、sFlt-1、miR-21-3p和miR-578水平对并发急性肾损伤的预测价值

Predictive value of pathogenic bacteria and levels of HMGB1, sFlt-1, miR-21-3p and miR-578 for development of acute kidney injury in patients with sepsis

    摘要
  • 摘要:
    目的 探究重症监护病房(ICU)脓毒症感染病原菌培养、药敏结果及高迁移率族蛋白1(HMGB1)、可溶性血管内皮生长因子受体-1(sFlt-1)、微小核糖核酸(miR)-21-3p、miR-578水平对并发急性肾损伤(AKI)的预测价值。
    方法 选取2021年11月-2024年11月宜昌市中心人民医院286例ICU脓毒症患者, 根据是否并发AKI分为AKI组(139例)、非AKI组(147例)。统计ICU脓毒症感染病原菌及药敏结果, 比较两组血清HMGB1、sFlt-1、miR-21-3p、miR-578水平, 分析四者对脓毒症并发AKI的预测价值。
    结果 286例ICU脓毒症患者分离出148株病原菌, 多是革兰阴性菌, 主要革兰阴性、阳性菌分别为鲍曼不动杆菌、金黄色葡萄球菌。鲍曼不动杆菌对环丙沙星、头孢曲松、头孢他啶、头孢吡肟耐药性高, 对米诺霉素耐药性低, 金黄色葡萄球菌对青霉素、红霉素耐药性高, 对利奈唑胺、替加环素、万古霉素耐药性低。AKI组血清HMGB1、sFlt-1、miR-21-3p水平较非AKI组高(P＜0.05), miR-578水平较非AKI组低(P＜0.05), 四者联合检测诊断ICU脓毒症并发AKI的AUC值较单一高(P＜0.05), 敏感度为88.50%, 特异度为74.80%。
    结论 ICU脓毒症感染多是革兰阴性菌, 鲍曼不动杆菌、金黄色葡萄球菌引起的感染推荐使用米诺霉素、利奈唑胺、替加环素、万古霉素。HMGB1、sFlt-1、miR-21-3p、miR-578参与脓毒症并发AKI的发生, 四者联合检测的预测价值高。

     

    Abstract:
    OBJECTIVE To explore the predictive value of pathogenic bacteria culture and drug sensitivity results, as well as the levels of high mobility group box 1 protein (HMGB1), soluble fms-like tyrosine kinase-1 (sFlt-1), microRNA (miR)-21-3p and miR-578, for the development of acute kidney injury (AKI) in patients with sepsis in the intensive care unit (ICU).
    METHODS A total of 286 patients with sepsis admitted to the ICU of the Yichang Central People′s Hospital from Nov. 2021 to Nov. 2024 were selected and divided into AKI and non-AKI groups (139 cases and 147 cases, respectively) based on whether they had concurrent AKI. The pathogenic bacteria and drug sensitivity results of patients with sepsis in the ICU were statistically analyzed. The levels of serum HMGB1, sFlt-1, miR-21-3p and miR-578 were compared between the two groups, and the predictive value of these four markers for sepsis complicated with AKI was analyzed.
    RESULTS Among 286 patients with sepsis in the ICU, 148 strains were isolated. Most of the isolated bacteria were gram-negative, with Acinetobacter baumannii and Staphylococcus aureus being the predominant gram-negative and gram-positive bacteria, respectively. A. baumannii exhibited high resistance to ciprofloxacin, ceftriaxone, ceftazidime and cefepime, but low resistance to minocycline. S. aureus showed high resistance to penicillin and erythromycin, but low resistance to linezolid, tigecycline and vancomycin. The levels of serum HMGB1, sFlt-1 and miR-21-3p were higher in the AKI group than those in the non-AKI group (P < 0.05), while the level of miR-578 was lower (P < 0.05). The combined detection of these four markers showed a higher AUC value for diagnosing ICU sepsis complicated with AKI than that of the individual markers (P < 0.05), with a sensitivity of 88.50% and a specificity of 74.80%.
    CONCLUSIONS Sepsis infections in the ICU are mostly caused by gram-negative bacteria, such as A. baumannii and S. aureus. It is recommended to use minocycline, linezolid, tigecycline and vancomycin for these infections. HMGB1, sFlt-1, miR-21-3p and miR-578 are involved in the occurrence of sepsis complicated with AKI, and the combined detection of these four markers has high predictive value.

     

    • HTML全文
    • 参考文献(26)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回
下载中心