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白细胞介素-17A在脓毒症相关性急性肾损伤患者风险分层及预后中的作用

The roles of interleukin-17A in risk stratification and prognosis of patients with sepsis-associated acute kidney injury.

作者信息

Jin Heng, Wei Wei, Zhao Yibo, Ma Ai, Sun Keke, Lin Xiaoxi, Liu Qihui, Shou Songtao, Zhang Yan

机构信息

Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China.

Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China.

出版信息

Kidney Res Clin Pract. 2023 Nov;42(6):742-750. doi: 10.23876/j.krcp.22.063. Epub 2023 May 23.

Abstract

BACKGROUND

The aim of this study was to evaluate the roles of interleukin (IL)-17A in risk stratification and prognosis of patients with sepsis-associated acute kidney injury (SAKI).

METHODS

We enrolled 146 sepsis patients (84 non-SAKI and 62 SAKI patients) admitted to the emergency department from November 2020 to November 2021. Patients with SAKI were differentiated based on the severity of acute kidney injury. All clinical parameters were evaluated upon admission before administering antibiotic treatment. Inflammatory cytokines were assessed using flow cytometry and the Pylon 3D automated immunoassay system (ET Healthcare). In addition, a receiver operating characteristic (ROC) curve was utilized to determine the prognostic values of IL-17A in SAKI.

RESULTS

The levels of creatinine, IL-2, IL-4, IL-6, IL-17A, tumor necrosis factor alpha, C-reactive protein, and procalcitonin (PCT) were significantly higher in the SAKI group than in the non-SAKI group (p < 0.05). The level of IL-17A revealed significant differences among stages 1, 2, and 3 in SAKI patients (p < 0.05). The mean levels of PCT, IL-4, and IL-17A were significantly higher in the non-survival group than in the survival group in SAKI patients (p < 0.05). In addition, the area under the ROC curve of IL-17A was 0.811. Moreover, the IL-17A cutoff for differentiating survivors from non-survivors was 4.7 pg/mL, of which the sensitivity and specificity were 77.4% and 71.0%, respectively.

CONCLUSION

Elevated levels of IL-17A could predict that SAKI patients are significantly prone to worsening kidney injury with higher mortality. The usefulness of IL-17A in treating SAKI requires further research.

摘要

背景

本研究旨在评估白细胞介素(IL)-17A在脓毒症相关性急性肾损伤(SAKI)患者风险分层及预后中的作用。

方法

我们纳入了2020年11月至2021年11月期间急诊科收治的146例脓毒症患者(84例非SAKI患者和62例SAKI患者)。SAKI患者根据急性肾损伤的严重程度进行区分。所有临床参数在给予抗生素治疗前入院时进行评估。使用流式细胞术和Pylon 3D自动免疫分析系统(ET Healthcare)评估炎性细胞因子。此外,利用受试者工作特征(ROC)曲线确定IL-17A在SAKI中的预后价值。

结果

SAKI组的肌酐、IL-2、IL-4、IL-6、IL-17A、肿瘤坏死因子α、C反应蛋白和降钙素原(PCT)水平显著高于非SAKI组(p<0.05)。SAKI患者1、2、3期的IL-17A水平存在显著差异(p<0.05)。SAKI患者中,非存活组的PCT、IL-4和IL-17A平均水平显著高于存活组(p<0.05)。此外,IL-17A的ROC曲线下面积为0.811。而且,区分存活者与非存活者的IL-17A临界值为4.7 pg/mL,其敏感性和特异性分别为77.4%和71.0%。

结论

IL-17A水平升高可预测SAKI患者肾损伤显著易加重且死亡率更高。IL-17A在治疗SAKI中的作用需要进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8220/10698064/b78576e99ef5/j-krcp-22-063f1.jpg

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