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投稿时间：2026-01-09 网络发布日期：2026-05-22
投稿时间：2026-01-09 网络发布日期：2026-05-22
中文摘要: 目的 探讨基于可溶性血栓调节蛋白（sTM）的联合指标对脓毒症患者发生急性肾损伤（AKI）的预测效能，为临床AKI的早期识别提供参考。方法 回顾性分析2024年1月至12月南京大学医学院附属鼓楼医院重症监护病房收治的364例脓毒症患者的临床资料。根据住院期间是否发生AKI［依据改善全球肾脏病预后组织（KDIGO）提出的诊断标准］分为 AKI 组（n=171）和非 AKI 组（n=193），比较两组患者的临床资料。采用多因素logistic回归分析筛选脓毒症发生AKI的危险因素；绘制受试者工作特征（ROC）曲线分析基于sTM的联合指标对脓毒症患者发生AKI的预测价值。结果 脓毒症相关AKI的发生率为46.98%，与非AKI组比较，AKI组患者急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分、28 d死亡率以及休克、呼吸衰竭、肝损伤的发生率均更高，sTM、C反应蛋白（CRP）、白细胞介素6、降钙素原、凝血酶原时间、活化部分凝血活酶时间水平更高，血小板水平降低，差异有统计学意义（P＜0.05）。多因素logistic回归分析显示，休克（OR =3.304，95%CI：2.001~5.457，P＜0.01）、肝损伤（OR =2.442，95%CI：1.399~4.265，P=0.002）、高APACHE Ⅱ评分（OR =1.050，95%CI：1.016~1.085，P=0.004）、高 sTM（OR =1.039，95%CI：1.018~1.060，P＜0.01）及 高 CRP（OR =1.003，95%CI：1.001~1.006，P=0.034）是脓毒症患者发生AKI的独立危险因素。sTM、休克以及APACHE Ⅱ评分三者联合预测脓毒症患者发生AKI的ROC曲线下面积为0.804（95%CI：0.759~0.850），敏感度为0.754，特异度为0.762。结论 高sTM是脓毒症患者发生AKI的独立危险因素，对脓毒症患者发生AKI具有一定预测价值，联合休克和APACHE Ⅱ后预测价值更高。
中文关键词: 可溶性血栓调节蛋白 急性肾损伤 脓毒症 休克 急性生理学与慢性健康状况评分Ⅱ
Abstract:Objective To investigate the predictive efficacy of combined indexes based on soluble thrombomodulin（sTM）for acute kidney injury（AKI）in patients with sepsis，and to provide a reference for the early identification of AKI in clinical practice. Methods A retrospective study was conducted to collect clinical data of 364 patients with sepsis admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital，the Affiliated Hospital of Nanjing University Medical School from January to December 2024. According to the occurrence of AKI during hospitalization［based on the diagnostic criteria proposed by Kidney Disease：Improving Global Outcomes（KDIGO）］，the patients were divided into AKI group（171 cases）and non-AKI group（193 cases）. The clinical data of the two groups were compared. Multivariate logistic regression analysis was used to screen the risk factors for AKI in sepsis patients.Receiver operating characteristic（ROC）curves were plotted to analyze the predictive value of combined indicators based on sTM for AKI in sepsis patients. Results The incidence of sepsis-associated AKI was 46.98%. Compared with the non-AKI group，the AKI group exhibited significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ）score，Sequential Organ Failure Assessment（SOFA）score，28-day mortality，and incidence rates of shock，respiratory failure，and liver injury（P＜0.05）. Levels of sTM，C-reactive protein（CRP），interleukin-6，procalcitonin，prothrombin time，and activated partial thromboplastin time were also significantly higher，whereas platelet count was significantly lower（P＜0.05）. Multivariate logistic regression analysis identified shock（OR =3.304，95%CI：2.001-5.457，P＜0.01），liver injury（OR =2.442，95%CI：1.399-4.265，P=0.002），high APACHE Ⅱ score（OR =1.050，95%CI：1.016-1.085，P=0.004），high sTM（OR =1.039，95%CI：1.018-1.060，P＜0.01），and high CRP（OR =1.003，95%CI：1.001-1.006，P=0.034）as independent risk factors for AKI in patients with sepsis. The combined use of sTM，shock，and APACHE Ⅱ score yielded an area under the curve（AUC）of 0.804（95%CI：0.759-0.850）for predicting AKI，with a sensitivity of 0.754 and a specificity of 0.762. Conclusion sTM is an independent risk factor for AKI in sepsis patients，and has certain predictive value for AKI in sepsis patients. The predictive value is more significant when combined with shock and APACHE Ⅱ score.
keywords: Soluble thrombomodulin Acute kidney injury Sepsis Shock Acute Physiology and Chronic Health Evaluation Ⅱ
文章编号： 中图分类号：R631 R692 文献标志码：A
基金项目:南京鼓楼医院临床研究专项资金项目（2024-LCYJ-PY-84）
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引用文本：
李静,严如玉,徐颖,等.基于可溶性血栓调节蛋白的联合指标对脓毒症相关急性肾损伤的预测价值[J].中国临床研究,2026,39(5):677-681.
李静,严如玉,徐颖,等.基于可溶性血栓调节蛋白的联合指标对脓毒症相关急性肾损伤的预测价值[J].中国临床研究,2026,39(5):677-681.