目的分析劳力型中暑（exertional heat stroke, EHS）合并横纹肌溶解（rhabdomyolysis, RM）患者中部分活化凝血活酶时间（activated partial thromboplastin, APTT）、乳酸脱氢酶-1（lactate dehydrogenase-1, LDH-1）及中性粒细胞（neutrophil granulocyte, NEU）与急性肾损伤（acute kidney injury, AKI）的相关性。
方法回顾性收集2008年5月至2019年11月在南部战区总医院住院的EHS患者261例，其中合并RM患者147例，收集患者基本资料及外周血指标，并根据是否合并AKI，将RM患者分为非AKI组和AKI组；采用二元Logistic回归分析RM合并AKI的独立影响因素，应用ROC曲线分析相关指标对RM并发AKI的预测价值。
结果147例RM患者中，合并有AKI患者57例（38.8%）。将RM是否合并AKI为因变量，将所有单因素分析差异具有统计学意义（ P<0.05）的变量作为自变量采用二分类Logistic分析得出模型1，采用前向筛选得出模型2。模型2结果显示：NEU（ OR=1.196，95% CI:1.082~1.322， P<0.05）、LDH-1（ OR=1.015，95% CI:1.005~1.024， P<0.05）及APTT（ OR=1.013，95% CI:1.004~1.022， P<0.05）是RM合并AKI患者的独立危险因素（均 P<0.05），其模型1的AIC为166.914，模型2 AIC为150.276，提示模型2优于模型1。此外，NEU、LDH-1联合APTT对RM并发AKI的预测价值：ROC曲线下面积为0.830（95% CI:0764~0.897），其临界值≥0.387时提示RM并发AKI，特异性为0.719，敏感度为0.811。
结论NEU、LDH-1及APTT与RM合并AKI密切相关，并通过联合检测NEU、LDH-1及APTT有助于早期诊断RM并发AKI。
ObjectiveTo investigate the relationship between partial activated thromboplastin time (APTT), lactate dehydrogenase-1 (LDH-1), neutrophil (NEU) and rhabdomyolysis (RM) -associated acute kidney injury (AKI) in exertional heat stroke (EHS) patients.
MethodsThe valid data of 261 EHS patients hospitalized in the General Hospital of the Southern Theater Command of the PLA from May 2008 to November 2019 were respectively included as the study objects, including 147 patients with RM. Basic data and peripheral blood indexes of the patients were collected, and the patients with RM were divided into non-AKI group and AKI group according to whether they had AKI. Binary Logistic regression was used to analyze the independent influencing factors of RM combined with AKI, and ROC curve was used to analyze the predictive value of relevant indicators on RM concurrent AKI.
ResultsAmong 147 patients with RM, 57 (38.8%) had AKI. Using whether RM was combined with AKI as the dependent variable, variables showing statistical significance ( P<0.05) in univariate analysis were included as independent variables. Model 1 was established through binary logistic regression analysis, while Model 2 was derived using forward selection. The results of Model 2 revealed that NEU ( OR=1.196, 95% CI: 1.082-1.322, P<0.05), LDH-1 ( OR=1.015, 95% CI: 1.005-1.024, P<0.05), and APTT ( OR=1.013, 95% CI: 1.004-1.022, P<0.05) were independent risk factors for RM patients complicated with AKI ( all P<0.05). The AIC value for Model 1 was 166.914, while that for Model 2 was 150.276, indicating that Model 2 outperformed Model 1. The predictive value of NEU, LDH-1 combined with APTT for RM complicated by AKI: The area under the ROC curve (AUC) was 0.830 (95% CI: 0.764-0.897). When the critical value is ≥0.387, it indicates RM complicated by AKI, with a specificity of 0.719 and a sensitivity of 0.811.
ConclusionsNEU, LDH-1 and APTT are closely related to AKI in RM, and the combined detection of NEU, LDH-1 and APTT is helpful for early diagnosis of AKI in RM.
戴靖榕,李慧,刘斌. 部分活化凝血活酶时间、乳酸脱氢酶-1及中性粒细胞在劳力型中暑合并横纹肌溶解所致急性肾损伤的相关性分析[J]. 中华急诊医学杂志,2025,34(03)：404-410.
DOI:10.3760/cma.j.issn.1671-0282.2025.03.018版权归中华医学会所有。
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戴靖榕进行文章的构思与设计，结果的统计学分析与解释，撰写论文；刘斌进行研究的实施与可行性分析，负责文章的质量控制及审校，对文章整体负责，监督管理；李慧进行数据收集、数据整理及录入、论文的修订
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