河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (11): 1295-1300.doi: 10.3969/j.issn.1007-3205.2023.11.010

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DKK3在脓毒症相关急性肾损伤早期诊断的意义

  

  1. 1.华北石油管理局总医院全科医学科，河北 任丘 062552；2.华北石油管理局总医院急诊医学科，河北 任丘  062552

  • 出版日期:2023-11-25 发布日期:2023-12-05
  • 作者简介:王炎（1975-），女，河北肃宁人，华北石油管理局总医院副主任医师，医学硕士，从事全科医学诊治研究。

Significance of DKK3 in early diagnosis of sepsis-associated acute renal injury

  1. 1.Department of General Practice, General Hospital of North China Petroleum Administration, Hebei 
    Province, Renqiu 062552, China; 2.Department of Emergency Medicine, General Hospital of North 
    China Petroleum Administration, Hebei Province, Renqiu 062552, China

  • Online:2023-11-25 Published:2023-12-05

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摘要： 目的 通过前瞻性研究探讨Dickkopf相关蛋白3（Dickkopf  WNT signaling pathway inhibitor 3，DKK3）对脓毒症相关性急性肾损伤（sepsis-induced acute kidney injury，SAKI）患者疾病发生及转归的预测价值。
方法 对华北石油管理局总医院在重症监护病房（intensive care unit，ICU）诊治的住院患者进行分组。完善入组临床实验室资料，应用急性生理和慢性健康评分Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHE Ⅱ）、序贯器官衰竭检测评分（sequential organ failure assessment，SOFA）及改善全球肾脏病预后组织（kidney disease improving global outcomes， KDIGO）分期进行入组风险评估。采用SPSS 21.0及GraphPad Prism 8.0.1进行统计学分析，组间比较分析有意义的相关因素，受试者工作特征曲线（receiver operating characteristic，ROC）分析预测模型的评估效能，P＜0.05为差异有统计学意义。
结果 本研究共纳入脓毒症患者80例，其中SAKI患者31例（38.75%），脓毒症未发生急性肾损伤（acute kidney injury，AKI）的患者49例（61.25%）；SAKI患者DKK3中位值显著高于脓毒症未发生AKI的患者（843（765.0,998.0），76（40.5,348.0）；P＜0.05）；DKK3中位值随着SAKI患者KDIGO分期的增加而升高ROC（P＜0.05）；ROC曲线得出，DKK3对脓毒症患者发生AKI的评估效能最优（AUC=0.978，P＜0.05），且相较于DKK3联合血清肌酐（serum creatinine，Scr），DKK3联合中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin，NGAL）对脓毒症患者发生AKI更优（AUC=0.989，P＜0.05）；预测SAKI患者疾病转归时，相较于单独使用DKK3，DKK3联合NGAL对SAKI患者发生慢性肾脏病（chronic kidney disease，CKD）的评估效能更优（AUC=0.979，P＜0.05）。 
结论 DKK3升高与脓毒症患者AKI的发生及AKI的严重程度相关，且DKK3与NGAL联合评估脓毒症患者发生AKI及疾病进展，能更好的早期识别高风险人群。


关键词: 肾疾病, Dickkopf相关蛋白3, 脂笼蛋白质类

Abstract: Objective To prospectively explore the predictive value of Dickkopf WNT signaling pathway inhibitor 3 (DKK3) for disease occurrence and outcome in patients with sepsis-associated acute kidney injury (SAKI). 
Methods The inpatients who were treated in the intensive care unit (ICU) in General Hospital of North China Petroleum Administration were divided into different groups. The clinical laboratory data of the enrolled patients were collected, and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), and the sequential organ failure assessment (SOFA) and kidney disease: improving global outcomes (KDIGO) stage were used for risk assessment of enrolled patients. SPSS 21.0 and GraphPad Prism 8.0.1 were used for statistical analysis, and significant correlation factors were compared and analyzed between groups. Receiver operating characteristic (ROC) curve was used to analyze the evaluation performance of the prediction model, and P＜0.05 was considered statistically significant. 
Results A total of 80 patients with sepsis were included in this study, including 31 (38.75%) with SAKI, and 49 (61.25%) with sepsis but without acute kidney injury (AKI). The median value of DKK3 in patients with SAKI was significantly higher than that in patients with sepsis but without AKI ［843 (765.0, 998.0), 76 (40.5, 348.0); P＜0.05］. The median value of DKK3 increased with the increase of KDIGO stage in SAKI patients (P＜0.05). ROC showed that DKK3 had the optimal evaluation efficacy on AKI in patients with sepsis (AUC=0.978, P＜0.05), and compared with DKK3 combined with serum creatinine (Scr), DKK3 combined with neutrophil gelatinase-associated lipocalin (NGAL) was more effective in treating AKI in patients with sepsis (AUC=0.989, P＜0.05). In predicting disease outcome in patients with SAKI, compared with DKK3 alone, DKK3 combined with NGAL was more effective in evaluating chronic kidney disease (CKD) in SAKI patients (AUC=0.979, P＜0.05). 
Conclusion The increase of DKK3 is associated with the occurrence of AKI and the severity of AKI in patients with sepsis, and the combination of DKK3 and NGAL can better identify high risk group in early stage by evaluating the occurrence of AKI and disease progression in patients with sepsis.


Key words: kidney diseases, Dickkopf-associated protein 3, lipocalins

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