RRI IVC-RVI联合血清Sirtuin3 mRNA对脓毒性休克继发急性肾损伤的早期预警效能及意义

doi:10.3969/j.issn.1006-6233.2025.05.020

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摘要 目的: 探讨肾阻力指数(RRI)、下腔静脉呼吸变异度(IVC-RVI)联合血清沉默信息调节因子3(Sirtuin3 mRNA)对脓毒性休克继发急性肾损伤(AKI)的早期预警效能及意义。方法: 选取2020年8月~2023年8月我院收治的185例脓毒性休克患者,根据是否继发AKI分为AKI组(90例)、非AKI组(95例)。比较两组基线资料、液体复苏0h、24h的RRI、IVC-RVI及血清Sirtuin3 mRNA,多因素Logistic回归分析RRI和IVC-RVI降低率、血清Sirtuin3 mRNA对脓毒性休克继发AKI的影响,受试者工作特征曲线(ROC)分析不同方案预测脓毒性休克继发AKI的价值。结果: AKI组APACHEⅡ评分、SOFA评分高于非AKI组(P<0.05);AKI组液体复苏0h、24h的RRI高于非AKI组,RRI降低率、Sirtuin3 mRNA低于非AKI组(P<0.05);AKI组液体复苏0h、24h的IVC-RVI低于非AKI组,IVC-RVI降低率高于非AKI组(P<0.05);多因素分析显示,RRI降低率、IVC-RVI降低率、Sirtuin3 mRNA均是脓毒性休克继发AKI的独立相关影响因素,三者每升高1个单位,可将AKI的风险增加0.402、1.365、0.398倍(P<0.05);ROC分析显示,传统方案:APACHEⅡ评分、SOFA评分预测脓毒性休克继发AKI的AUC分别为0.729、0.744(P<0.001);新型方案:RRI降低率、IVC-RVI降低率、Sirtuin3 mRNA及三者联合预测脓毒性休克继发AKI的AUC分别为0.758、0.766、0.773、0.921(P<0.001);RRI降低率+IVC-RVI降低率+Sirtuin3 mRNA的AUC显著大于APACHEⅡ评分、SOFA评分、RRI降低率、IVC-RVI降低率、Sirtuin3 mRNA(P<0.05);敏感性分析显示,与联合比较,APACHEⅡ评分+联合、SOFA评分+联合、APACHEⅡ评分+SOFA评分+联合的AUC值无显著提升(P>0.05),提示包含APACHEⅡ评分、SOFA评分的预测方案不会增加预测价值,剔除后也对联合预测结果无显著影响。结论: 液体复苏后24h RRI降低率、IVC-RVI降低率和血清Sirtuin3 mRNA均与脓毒性休克继发AKI密切相关,三者联合能预警AKI的发生风险,且预测价值高于传统的APACHEⅡ评分、SOFA评分,能为临床预警AKI以及减少AKI的发生提供参考。

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	冯宁
	潘璐
	郭昆
	张永根

关键词 ：肾阻力指数, 下腔静脉呼吸变异度, 血清沉默信息调节因子3, 脓毒性休克, 急性肾损伤, 预警效能

Abstract：Objective: To investigate the early warning efficacy and significance of renal resistance index (RRI), inferior vena cava respiratory variability index (IVC-RVI), and serum silent information regulator 3 (Sirtuin3 mRNA) in predicting acute kidney injury (AKI) secondary to septic shock. Methods: A total of 185 patients with septic shock admitted to our hospital from August 2020 to August 2023 were enrolled and divided into an AKI group (90 cases) and a non-AKI group (95 cases) based on whether AKI developed. Baseline data, RRI, IVC-RVI, and serum Sirtuin3 mRNA levels at 0 hours and 24 hours after fluid resuscitation were compared between the two groups. Multivariate logistic regression was used to analyze the effects of RRI reduction rate, IVC-RVI reduction rate, and serum Sirtuin3 mRNA on AKI secondary to septic shock. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of different models for AKI secondary to septic shock. Results: The APACHE II score and SOFA score in the AKI group were significantly higher than those in the non-AKI group (P<0.05). The RRI at 0h and 24h of fluid resuscitation in the AKI group was higher than that in the non-AKI group, and the decrease rate of RRI and Sirtuin3 mRNA were lower than those in the non-AKI group (P<0.05). The IVC-RVI at 0h and 24h of fluid resuscitation in the AKI group was lower than that in the non-AKI group, and the decrease rate of IVC-RVI was higher than that in the non-AKI group (P<0.05). Multivariate analysis showed that the reduction rate of RRI, the reduction rate of IVC-RVI, and Sirtuin3 mRNA were all independent factors associated with AKI secondary to septic shock. Each unit increase in these three factors increased the risk of AKI by 0.402, 1.365, and 0.398 times, respectively (P<0.05). ROC analysis showed that the AUC of traditional schemes: APACHE II score and SOFA score for predicting AKI secondary to septic shock were 0.729 and 0.744, respectively (P<0.001). New scheme: The AUC of RRI reduction rate, IVC-RVI reduction rate, Sirtuin3 mRNA, and the combination of the three for predicting AKI secondary to septic shock were 0.758, 0.766, 0.773, and 0.921, respectively (P<0.001). The RRI reduction rate + IVC-RVI reduction rate + AUC of Sirtuin3 mRNA were significantly greater than the APACHE II score, SOFA score, RRI reduction rate, IVC-RVI reduction rate, and Sirtuin3 mRNA (P<0.05). Sensitivity analysis showed that compared with the combination, the AUC values of Apache Ⅱ score+combination, SOFA score+combination, Apache Ⅱ score+SOFA score+combination were not significantly improved (P>0.05), suggesting that the prediction scheme including Apache Ⅱ score and SOFA score would not increase the prediction value, and had no significant impact on the joint prediction results after elimination. Conclusion: The reduction rate of RRI, IVC-RVI, and serum Sirtuin3 mRNA after 24 hours of fluid resuscitation are closely related to the occurrence of AKI secondary to septic shock. The combination of the three can provide early warning of the risk of AKI, and has higher predictive value than the traditional APACHE II score and SOFA score, providing a reference for clinical early warning of AKI and reducing the occurrence of AKI.

Key words： Renal resistance index Inferior vena cava respiratory variability index Sirtuin3 mRNA Septic shock Acute kidney injury Early warning efficacy

基金资助:江西省卫生健康委科技计划课题,(编号:202140547)

引用本文:

冯宁, 潘璐, 郭昆, 张永根. RRI IVC-RVI联合血清Sirtuin3 mRNA对脓毒性休克继发急性肾损伤的早期预警效能及意义[J]. 河北医学, 2025, 31(5): 816-823.
FENG Ning, PAN Lu, GUO Kun, et al. Early Warning Efficacy and Significance of Renal Resistance Index (RRI) Inferior Vena Cava Respiratory Variability Index (IVC-RVI) Combined with Serum Sirtuin3 mRNA for Acute Kidney Injury Secondary to Septic Shock. HeBei Med, 2025, 31(5): 816-823.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.05.020 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I5/816

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