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Received:August 30, 2023 Published Online:June 20, 2024
Received:August 30, 2023 Published Online:June 20, 2024
中文摘要: 目的 探讨运动性横纹肌溶解症（ERB）的发病特点及肌酸激酶（CK）、肌红蛋白/肌酸激酶（Mb/CK）等指标对ERB患者合并急性肾损伤（AKI）的预测价值。方法 回顾性分析2013年1月至2022年9月青岛大学附属医院收治的154例ERB患者的临床资料，根据是否合并AKI分为AKI组（n=35）和非AKI组（n=119），收集肌酐、CK等实验室指标。采用单因素和多因素logistic回归模型分析影响ERB患者是否合并AKI的危险因素，绘制受试者工作特征曲线（ROC曲线）评估相关指标的预测价值。应用Spearman相关分析法分析其与血肌酐的相关性。结果 154例ERB患者主要临床表现为肌肉疼痛（140例），肢体乏力（69例），浓茶色尿（36例）。非AKI组的CK、肌酸激酶同工酶（CK-MB）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）显著高于AKI组（P＜0.05）；AKI组的肌酐、乳酸脱氢酶（LDH）、胱抑素C、Mb/CK、肌酐/胱抑素C高于非AKI组，差异有统计学意义（P<0.05）。ERB患者的Mb/CK（r=0.297，P<0.001）、胱抑素C（r=0.419，P<0.001）与血肌酐呈正相关，与CK（r=-0.191，P=0.018）、CK-MB（r=-0.200，P=0.013）、ALT（r=-0.271，P=0.001）、AST（r=-0.308，P<0.001）均呈负相关。多因素logistic回归分析显示LDH ［1.001(1.001~1.001)］、Mb/CK［1.010(1.006~1.014)］、胱抑素C［1.031(1.011~1.050)］、Mb/肌酐［1.007(1.001~1.013)］、肌酐/胱抑素C［1.008(1.000~1.015)］是ERB患者合并AKI的独立危险因素（P＜0.05）。ROC曲线分析显示肌酐（AUC＝0.753）、Mb/CK（AUC＝0.989）、LDH（AUC＝0.800）、CK（AUC＝0.815）、ALT（AUC＝0.667）、AST（AUC＝0.694）、胱抑素C（AUC＝0.673）、肌酐/胱抑素C（AUC＝0.702）、CK-MB（AUC＝0.752）对预测ERB患者是否合并AKI具有一定价值（P<0.05），其中Mb/CK预测效能最佳。结论 LDH、Mb/CK、胱抑素C、Mb/肌酐、肌酐/胱抑素C是影响ERB患者是否合并AKI的独立危险因素，肌酐、LDH、CK、ALT、AST、CK-MB、胱抑素C、Mb/CK、肌酐/胱抑素C可作为预测ERB患者合并AKI风险的评价指标；其中Mb/CK、肌酐/胱抑素C为新型预测指标。
Abstract:Objective To investigate the characteristics of exertional rhabdomyolysis (ERB) and the predictive value of creatine kinase (CK), myoglobin/creatine kinase (Mb/CK) ratio and other indicators for ERB patients with acute renal injury (AKI). Methods The clinical data of 154 patients with ERB admitted to the Affiliated Hospital of Qingdao University from January 2013 to September 2022 were retrospectively analyzed. The patients were divided into AKI group (n=35) and non-AKI group (n=119) according to whether AKI was combined. Creatinine, CK and other laboratory indicators were collected. Univariate and multivariate logistic regression models were used to analyze the risk factors for AKI in ERB patients. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of related indicators, and the correlation between each indicator and serum creatinine was analyzed by Spearman correlation analysis. Results The main clinical manifestations of 154 ERB patients were muscle pain (140 cases), limb weakness (69 cases), and dark brown urine (36 cases). The levels of CK, creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in non-AKI group were significantly higher than those in AKI group (P＜0.05). The levels of creatinine, lactate dehydrogenase (LDH), cystatin C, Mb/CK and creatinine/cystatin C in AKI group were higher than those in non-AKI group, and the differences were statistically significant (P<0.05). In ERB patients, Mb/CK (r=0.297, P<0.001), cystatin C (r=0.419, P<0.001) were positively correlated with serum creatinine, and CK (r=-0.191, P=0.018), CK-MB (r=-0.200, P=0.013), ALT (r=-0.271, P=0.001), AST (r=-0.308, P<0.001) were negatively correlated with serum creatinine. Multivariate logistic regression analysis showed that LDH ［1.001 (1.001-1.001)］, Mb/CK ［1.010 (1.006-1.014)］, cystatin C ［1.031 (1.011-1.050)］, Mb/creatinine ［1.007 (1.001-1.013)］, creatinine/cystatin C ［1.008 (1.000-1.015)］ were independent risk factors for AKI in ERB patients (P＜0.05). ROC curve analysis showed creatinine (AUC＝0.753), Mb/CK (AUC＝0.989), LDH (AUC＝0.800), CK (AUC＝0.815), ALT (AUC＝0.667), AST (AUC＝0.694), cystatin C (AUC＝0.673), creatinine/cystatin C (AUC＝0.702), and CK-MB (AUC＝0.752) had certain value in predicting whether patients with ERB had AKI (P<0.05), and Mb/CK had the best predictive efficacy. Conclusion LDH, Mb/CK, Cystatin C, Mb/creatinine, and creatinine/cystatin C are independent risk factors for ERB patients with AKI. Creatinine, LDH, CK, ALT, AST, CK-MB, cystatin C, Mb/CK, and creatinine/cystatin C can be used as evaluation indicators for predicting the risk of ERB patients with AKI. Among them, Mb/CK and creatinine/cystatin C are new predictive indicators.
keywords: Rhabdomyolysis Creatinine Creatine kinase Myoglobin Cystatin C Acute kidney injury Lactate dehydrogenase Alanine aminotransferase Aspartate aminotransferase
文章编号： 中图分类号：R685.5 文献标志码：A
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