Department of Emergency, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Endocrinology and Metabolism, Minhang Hospital, Fudan University, Shanghai, China.
Int Urol Nephrol. 2024 Sep;56(9):3039-3045. doi: 10.1007/s11255-024-04054-0. Epub 2024 Apr 18.
Acute kidney injury (AKI) is a complication commonly occurred in patients with sepsis, and AKI has become the leading cause associated with mortality. PKM2, as a rate-limiting enzyme of glycolysis, was considered to be involved in AKI in vitro and animal models. However, there have been no studies reported on the expression of PKM2 in humans and its association with AKI.
A retrospective study including 57 patients (35 males and 22 females) that were admitted into hospital in 2019 was carried out in our research. The basic characteristics and clinical parameters of each patient were collected from patients' medical records. We assessed changes in the expression of serum and urinary PKM2 using ELISA and its association with clinical manifestations in patients with sepsis through correlation analysis. Besides, ROC analysis was applied for evaluating the role of PKM2 in predicting AKI and death rate.
Urinary PKM2 is obviously increased in patients with sepsis-associated AKI (P < 0.05), while no significant change was found in the expression of serum PKM2. Moreover, the expression of urinary PKM2 is positively correlated with serum creatinine (r=0.577, P < 0.01) and blood-urea-nitrogen (r=0.531, P<0.01). In addition, it is negatively correlated with glomerular filtration rate (r=-0.583, P<0.01). Besides, ROC analysis indicated that urinary PKM2 could be a predictor of AKI in patients with sepsis (AUC-ROC, 0.819; SE, 0.086, P = 0.004, 95% CI 0.651-0.986).
Urinary PKM2 could be a marker predicting acute kidney injury in patients with sepsis.
急性肾损伤（AKI）是脓毒症患者常见的并发症，AKI 已成为与死亡率相关的主要原因。PKM2 作为糖酵解的限速酶，被认为与体外和动物模型中的 AKI 有关。然而，目前尚未有研究报道 PKM2 在人体中的表达及其与 AKI 的关系。
我们进行了一项回顾性研究，纳入了 2019 年住院的 57 名患者（35 名男性和 22 名女性），从患者病历中收集每位患者的基本特征和临床参数。我们使用 ELISA 评估血清和尿 PKM2 的表达变化，并通过相关性分析评估其与脓毒症患者临床表现的关系。此外，我们还应用 ROC 分析评估 PKM2 在预测 AKI 和死亡率中的作用。
脓毒症相关 AKI 患者的尿 PKM2 明显升高（P<0.05），而血清 PKM2 的表达无明显变化。此外，尿 PKM2 的表达与血清肌酐（r=0.577，P<0.01）和血尿素氮（r=0.531，P<0.01）呈正相关。此外，它与肾小球滤过率（r=-0.583，P<0.01）呈负相关。此外，ROC 分析表明尿 PKM2 可作为脓毒症患者 AKI 的预测指标（AUC-ROC，0.819；SE，0.086，P=0.004，95%CI 0.651-0.986）。
尿 PKM2 可能是预测脓毒症患者急性肾损伤的标志物。
