黄 婷,廖海波,李丹江,颜家虹,李巧丽

目的：脓毒性休克相关性急性肾损伤（AKI）是导致患者预后不良的常见危重并发症，目前缺乏理想的早期预警指标。本研究旨在评估活化部分凝血活酶时间（APTT）的动态变化对该肾损伤的早期诊断及预后预测价值。方法：我们采用回顾性研究方法，比较了肾损伤组与非肾损伤组患者入院时APTT及序贯器官衰竭评分（SOFA）的差异，并通过受试者工作特征（ROC）曲线分析评估其诊断效能，同时分析APTT动态变化与肾损伤进展及28天死亡率的关系。结果：脓毒性休克相关性肾损伤组患者入院时APTT及SOFA评分均显著高于非肾损伤组。ROC曲线分析提示入院时APTT对脓毒性休克相关性肾损伤显示出潜在的诊断价值（曲线下面积AUC>0.8）。APTT的动态升高（尤其第4-7天的变化值）与肾损伤加重、更高的28天死亡率显著相关；第7天APTT值及第4-7天APTT变化值对28天死亡风险具有潜在的预测价值（AUC分别为0.763和0.740）。结论：APTT可能作为脓毒性休克相关性肾损伤的潜在预警指标，其动态变化趋势能敏感反映脓毒性休克相关性肾损伤的进展并预测28天死亡风险，提示其可能作为脓毒性休克相关性肾损伤的风险预警与潜在的预后评估指标。

脓毒性休克；急性肾损伤；活化部分凝血活酶时间；诊断；预后

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