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目的：研究脓毒症并发急性肾损伤（AKI）患者血清成纤维细胞生长因子-21（FGF-21）、成纤维细胞生长因子-23（FGF-23）检测的临床价值。方法：选取2020年5月~2023年8月贵州医科大学附属白云医院和贵州医科大学附属医院收治的202例脓毒症患者，根据是否并发AKI分为非AKI组（n=109）和AKI组（n=93），同期选取体检的70例健康志愿者作为健康组。根据脓毒症并发AKI患者28 d临床结局将其分为死亡组和存活组。检测血清FGF-21、FGF-23水平。采用多因素Logistic回归模型分析脓毒症并发AKI患者28 d死亡的影响因素，受试者工作特征（ROC）曲线分析血清FGF-21、FGF-23对脓毒症并发AKI患者28 d死亡的预测价值。结果：与健康组相比，非AKI组和AKI组血清FGF-21、FGF-23水平显著升高（P＜0.05）；与非AKI组相比，AKI组血清FGF-21、FGF-23水平显著升高（P＜0.05）。93例脓毒症并发AKI患者，28d死亡26例，死亡率为27.96%。与存活组相比，死亡组血清FGF-21、血清FGF-23显著升高（P＜0.05）。多因素Logistic回归分析显示AKI分期Ⅱ～Ⅲ期、APACHEⅡ评分升高、SOFA评分升高、血清FGF-21升高、血清FGF-23升高是脓毒症并发AKI患者28 d死亡的危险因素（P＜0.05）。ROC曲线结果显示，FGF-21与FGF-23联合预测脓毒症并发AKI患者28 d死亡的AUC、灵敏度、特异度分别为0.798、0.769、0.791，均著优于单项检测。结论：血清FGF-21、FGF-23在脓毒症并发AKI患者中均呈高表达，与脓毒症并发AKI患者28 死亡相关。血清FGF-21、FGF-23联合检测对于脓毒症并发AKI患者28 d死亡的预测价值较高。

英文摘要:

Objective:To study the clinical value of serum fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) detection in patients with sepsis combine with acute kidney injury (AKI). Methods:202 patients with sepsis admitted to Baiyun Hospital Affiliated to Guizhou Medical University and the Affiliated Hospital of Guizhou Medical University from May 2020 to August 2023 were selected, and patients were divided into non-AKI group (n=109) and AKI group (n=93) according to whether they were combine with AKI, 70 healthy volunteers who underwent physical examinations in our hospital were selected as health group during the same period. Patients were divided into death group and survival group according to the 28-day clinical outcome of patients with sepsis combine with AKI. Serum FGF-21 and FGF-23 levels were detected. The influencing factors of 28-day death in patients with sepsis combine with AKI were analyzed by multivariate Logistic regression model, the predictive value of serum FGF-21 and FGF-23 for 28-day death in patients with sepsis combine with AKI were analyzed by receiver operating characteristic (ROC) curve. Results:Compared with healthy group, the levels of serum FGF-21 and FGF-23 in non-AKI group and the AKI group were significantly increased (P<0.05). Compared with non-AKI group, the serum levels of FGF-21 and FGF-23 in AKI group were significantly increased (P<0.05). Among 93 patients with sepsis combine with AKI, 26 died within 28 days, with a mortality rate of 27.96%. Compared with survival group, the serum FGF-21 and serum FGF-23 in death group were significantly increased (P<0.05). Multivariate Logistic regression analysis showed that AKI stage Ⅱ～Ⅲ, increased APACHE II score, increased SOFA score, increased serum FGF-21 and increased serum FGF-23 were risk factors for 28-day death in patients with sepsis combine with AKI (P<0.05). ROC curve results showed that, the AUC, sensitivity and specificity of FGF-21 combine with FGF-23 in predicting 28-day death in patients with sepsis combine with AKI were 0.798, 0.769 and 0.791 respectively, which were significantly better than those of single detection. Conclusion:Serum FGF-21 and FGF-23 are highly express in patients with sepsis combine with AKI, which are relate to 28 deaths in patients with sepsis combine with AKI. The combine detection of serum FGF-21 and FGF-23 has a high predictive value for 28-day death in patients with sepsis combine with AKI.

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