河北医学2025，Vol.31Issue(5)：816-823,8.DOI:10.3969/j.issn.1006-6233.2025.05.020
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
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
摘要
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 di-vided 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 resuscita-tion 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 dif-ferent 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,re-spectively(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 Sir-tuin3 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 com-bination,the AUC values of Apache Ⅱ score+combination,SOFA score+combination,Apache Ⅱ score+SO-FA score+combination were not significantly improved(P>0.05),suggesting that the prediction scheme in-cluding Apache Ⅱ score and SOFA score would not increase the prediction value,and had no significant im-pact 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 seconda-ry 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.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Key words
Renal resistance index/Inferior vena cava respiratory variability index/Sirtuin3 mR-NA/Septic shock/Acute kidney injury/Early warning efficacy引用本文复制引用
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):816-823,8.基金项目
江西省卫生健康委科技计划课题,(编号:202140547) （编号:202140547）
