目的 探究凝血指标联合血清单核细胞趋化蛋白-1(monocyte chemotactic protein-1， MCP-1)对慢性肾脏病患者急性肾损伤的预测价值。 方法 选择2021年1月─2023年6月于联勤保障部队第九〇八医院收治的慢性肾脏病患者155例为研究对象，比较急性肾损伤组(40例)及急性肾损伤未发生组(115例)患者的临床基本资料、凝血指标、MCP-1水平。探究影响慢性肾脏病患者急性肾损伤发生的主要风险因素及凝血指标、MCP-1预测慢性肾脏病患者急性肾损伤的临床价值。 结果 急性肾损伤组患者的凝血酶时间(TT)、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、MCP-1水平较未发生组升高(t=20.506、20.551、21.120、16.230；均P＜0.001)；急性肾损伤组患者纤维蛋白原(FIB)水平较未发生组降低(t=8.441；P＜0.001)。慢性肾脏病患者急性肾损伤与年龄、性别、体质量指数(body mass index,BMI)、糖尿病无关(t=0.521、0.760、0.648、2.399；P=0.477、0.383、0.341、0.121)，与舒张压、收缩压、血尿酸、空腹血糖、总胆固醇(TC)、血肌酐(Scr)、三酰甘油(TAG)、高脂血症、高血压有关(t=15.681、12.942、11.694、6.914、12.836、8.392、9.724、14.856、11.372；均P＜0.001)。以慢性肾脏病患者发生急性肾损伤为因变量，临床资料中P＜0.05的变量为自变量行多因素Logistic回归分析，结果显示收缩压、舒张压、空腹血糖、血尿酸、TC、TAG、Scr、高血压、高脂血症、PT、TT、FIB、APTT、MCP-1为慢性肾脏病患者急性肾损伤发生的主要危险因素(OR值分别为：3490、3.357、3.050、2.980、3.264、2.861、3.287、2.939、3.466、9.196、3.350、3.281、2.974、3.404；95% CI分别为：2.210～4.770、1.947～4.767、1.862～4.238、1.838～4.122、2.104～4.424、1.751～3.971、2.065～4.510、1.813～4.065、2.416～4.516、1.982～4.410、2.082～4.618、2.103～4.459、1.780～4.168、2.092～4.716；P值分别为：0.002、0.004、0.005、0.002、＜0.001、＜0.001、＜0.001、0.007、0.002、＜0.001、＜0.001、＜0.001、＜0.001、＜0.001)。 结论 TT、APTT、PT、FIB、MCP-1水平与患者急性肾损伤发生有关，对慢性肾脏病患者急性肾损伤有较好的预测价值。
Objective To explore the predictive value of coagulation markers combined with serum monocyte chemotaxis protein-1 (MCP-1) for acute kidney injury(AKI)in patients with chronic kidney disease(CKD). Methods A total of 155 CKD patients were admitted to our hospital from January 2021 to June 2023, among which 40 patients had AKI. Clinical data, coagulation indices and serum MCP-1 were compared between the 40 patients with AKI and the 115 CKD patients without AKI. The important risk factors for the presence of AKI and the value of coagulation indices combined with serum MCP-1 for the prediction of AKI in CKD patients was explored. Results Thrombin time (TT), activated partial thrombin time (APTT), prothrombin time(PT)and serum MCP-1 were higher in AKI group than in non-AKI group (t=20.506,20.551,21.120 and 16.230 respectively; P＜0.001); fibrinogen(FIB)was lower in AKI group than in non-AKI group (t=8.441,P＜0.001). The presence of AKI was not related to age, sex, body mass index (BMI) and diabetes mellitus (t=0.521, 0.760, 0.648 and 2.399 respectively; P=0.477, 0.383, 0.341 and 0.121 respectively), but was related to diastolic blood pressure, systolic blood pressure, serum uric acid, fasting blood glucose, total cholesterol(TC),serum creatinine(Scr), triglyceride(TAG), hyperlipidemia and hypertension (t=15.681, 12.942, 11.694, 6.914, 12.836, 8.392, 9.724, 14.856 and 11.372 respectively; P＜0.001). Multivariate logistic regression using the presence of AKI as the dependent variable and the factors with P values＜0.05 described above as the independent variables demonstrated that systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood uric acid, TC, TAG, Scr, hypertension, hyperlipidemia, PT, TT, FIB, APTT and MCP-1 were the main risk factors for AKI in CKD patients (OR value=3490, 3.357, 3.050, 2.980, 3.264, 2.861, 3.287, 2.939, 3.466, 9.196, 3.350, 3.281, 2.974 and 3.404 respectively; 95% CI： 2.210～4.770, 1.947～4.767, 1.862～4.238, 1.838～4.122, 2.104～4.424, 1.751～3.971, 2.065～4.510, 1.813～4.065, 2.416～4.516, 1.982～4.410, 2.082～4.618, 2.103～4.459, 1.780～4.168 and 2.092～4.716 respectively; P=0.002, 0.004, 0.005, 0.002, ＜0.001, ＜0.001, ＜0.001, 0.007, 0.002, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). Conclusion The levels of TT, APTT, PT, FIB and MCP-1 are related to the occurrence of AKI, and have the ability to predict the occurrence of AKI in CKD patients.
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