广西医学

目的探讨血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平联合急性生理和慢性健康状况评估Ⅱ（APACHEⅡ）评分对重症肺炎并发急性肾损伤（AKI）患者预后的预测价值。方法选取161例重症肺炎并发AKI患者作为AKI组，80例单纯重症肺炎患者作为非AKI组，再根据AKI组患者入院30 d的预后情况将其分为死亡组（n=54）和存活组（n=107）。比较AKI组和非AKI组患者的血清NGAL水平和APACHEⅡ评分。比较死亡组和存活组患者的临床资料，采用多因素Logistic回归模型分析重症肺炎并发AKI患者预后的影响因素，绘制受试者工作特征（ROC）曲线评估血清NGAL水平联合APACHEⅡ评分对重症肺炎并发AKI患者预后的预测价值。结果与非AKI组比较，AKI组患者血清NGAL水平和APACHEⅡ评分升高（P<0.05）。年龄增长、AKI分期2~3期、血清NGAL水平升高和APACHEⅡ评分升高为重症肺炎并发AKI患者死亡的独立危险因素（P<0.05）。ROC曲线分析结果显示，血清NGAL水平联合APACHEⅡ评分预测重症肺炎并发AKI患者预后的曲线下面积为0.873，大于血清NGAL水平和APACHEⅡ评分单独预测的曲线下面积（P<0.05）。结论重症肺炎并发AKI患者血清NGAL水平和APACHEⅡ评分升高与预后不良密切相关，血清NGAL水平联合APACHEⅡ评分对重症肺炎并发AKI患者预后具有较高的预测效能。

Objective To investigate the predictive value of serum neutrophil gelatinase associated lipocalin (NGAL) level combined with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score on prognosis in patients with severe pneumonia and concomitant acute kidney injury (AKI). Methods A total of 161 patients with severe pneumonia and concomitant AKI were selected as AKI group, and 80 patients with severe pneumonia alone as non⁃AKI group. Patients of the AKI group were further assigned to death group (n=54) or survival group (n=107) according to prognostic status 30 days after admission. The level of serum NGAL and APACHEⅡ score were compared between the AKI group and the non⁃AKI group. The clinical data of patients were compared between the death group and the survival group. The multivariate Logistic regression model was used to analyze the influencing factors for prognosis in patients with severe pneumonia and concomitant AKI. The predictive value of serum NGAL level combined with APACHEⅡ score on prognosis of patients with severe pneumonia and concomitant AKI was evaluated by drawing the receiver operating characteristic (ROC) curve. Results Compared with the non⁃AKI group, the AKI group exhibited elevated serum NGAL level and APACHEⅡ score (P<0.05). Increase of age, AKI stage in 2-3, elevation of serum NGAL level, and increase of APACHEⅡ score were the independent risk factors for prognosis in patients with severe pneumonia and concomitant AKI (P<0.05). The results of ROC curve analysis revealed that area under the curve of serum NGAL level combined with APACHEⅡ score for predicting prognosis in patients with severe pneumonia and concomitant AKI was 0.873, which was larger than areas under the curve predicted by serum NGAL level and APACHEⅡ score alone (P<0.05). Conclusion The elevations of serum NGAL level and APACHEⅡ score in patients with severe pneumonia and concomitant AKI are closely associated with adverse prognosis, serum NGAL level combined with APACHEⅡ score on prognosis of patients with severe pneumonia and concomitant AKI exerts relatively high prediction efficiency.