| Objective: To investigate the difference of carnitine spectrum between patients with acute renal injury and those with normal renal function.To investigate the relationship between free carnitine and total carnitine in patients with acute kidney injury and the severity and prognosis of the disease.Methods: From September 2015 to December 2018,55 newly diagnosed patients with acute kidney injury in zhongshan hospital affiliated to dalian university(a total of 55 patients meeting the inclusion criteria)were collected as the acute kidney injury group,and their blood samples were recorded within 24 hours after diagnosis.The serum free carnitine and acylcarnitine levels were determined by tandem mass spectrometry.Patients with normal renal function and meeting the inclusion criteria(a total of 58 patients met the inclusion criteria)were selected as the control group and their serum free carnitine and acylcarnitine levels were recorded.At the same time,the name,gender,age,basic disease,creatinine,total length of stay,Outcome of this hospitalization,and 28-day prognosis of the patients were recorded.To compare the carnitine spectrum differences between the acute kidney injury group and the control group with normal renal function.The correlation between creatinine and free carnitine and total carnitine concentration in acute renal injury group was analyzed.According to the group kidney Disease prognosis(Kinney diseases: Improving Global Outcomes,KDIGO)staging criteria of acute kidney injury groups in installment,the severity of kidney damage and according to the stage of stage 1,2,3 corresponding divided into Asubgroup of 1 group,2 group and 3 group,grouping analysis different kidney injury stage in patients with serum free carnitine and total carnitine concentration and correlation;The survival of the acute kidney injury group after 28 days was tracked and divided into subgroup B,survival group and death group.The relationship between free carnitine,total carnitine and prognosis was analyzed.The total number of days of hospitalization of patients in the acute kidney injury group was calculated.According to the total number of days of hospitalization,patients in the C subgroup were divided into the group with the total number of days of hospitalization greater than 25 days and the group with the total number of days of hospitalization less than or equal to 25 days.Analysis of gender,age,treatment(dialysis),AP ? score,basic disease(presence of shock,severe pneumonia,acute myocardial infarction,pulmonary embolism),total carnitine and free carnitine has relationship with the patient in the hospital.Results: 1.Acute kidney injury group of serum free carnitine and total carnitine concentration was reduced,short chain acyl carnitine concentration was increased,long-chain acyl carnitine C14DC?C16-OH?C161-OH?C20?C24 was increased,with statistical significance(p < 0.05),other long-chain acyl carnitine has also incre ased the trend.2.In the acute kidney injury group,serum free carnitine concentration was negatively correlated with creatinine value[(32.78±10.65)?mol/L,r=-0.328,p=0.014],and serum total carnitine concentration was negatively correlated with creatinine value [(55.0716.63)?mol/L,r=-0.395,p=0.003].A subgroups:? group a total of 15 cases,? group of 33 cases with ? group a total of 7 cases,different points of patients during the period of free carnitine statistical differences,three groups respectivel [(37.04 + 9.64),(32.98-9.79)?mol/L,(22.69-11.36)?mol/L,f = 4.99,p = 0.010],different points during the total concentration of carnitine in patients with statistical differences,three groups respectively [(62.40 + 18.47)?mol/L,(55.64-13.97)?mol/L,(36.70 11.06)?mol/L,f=7.027,p=0.020].3.A total of 18 patients with acute kidney injury in the group died,a total of 37 patients with survivald,and the death of group B and survival the patient's serum freecarnitine concentration differences between groups are statistically significant,death group,the survival group,respectively[20.55(16.12,26.57)?mol/L,37.44(32.16,45.32)?mol/L,p=0.000].Death group and survival the patient's serum total carnitine concentration differences between there is statistical significance,death group,the survival group[36.39(22.34,43.12)?mol/L,59.31(43.54,69.87)?mol/L,p=0.000],the mortality of the patients was negatively correlated with the serum free carnitine(r=-0.724,p= 0.000).Themortality of patients was also negatively correlated with total carnitine(r=-0.596,p= 0.000).4.The total length of hospital stay of the 55 AKI patients in the acute kidney injury group was(22.56±9.48)d,and the total number of days of hospital stay was greater than25 days,a total of 28 cases,and the total number of days of hospital stay was less than or equal to 25 days,a total of 27 cases.Total hospitalization days is more than 25 days group,total hospitalization days ? 25 days,total patients > 25 days of hospitalization days and total hospitalization days ? 25 days to statistical differences in the patient's serum free carnitine(t= 6.547,p= 0.000),the total number of days in hospital patients with more than 25 days and total hospitalization days less than or equal to 25 days to statistical differences in the patient's serum total carnitine(t= 5.560,p=0.000).5.The treatment of patients with acute kidney injury,AP?score,total carnitine and free carnitine correlated with length of hospital stay and patients(p< 0.05),gender,age,disease and length of hospital stay in patients with no correlation(p> 0.05).Treatment,the AP ? score,total carnitine and free carnitine in the Cox proportional hazards regression model for multiple factors analysis,found that after treatment(dialysis)and AP?score is the independent factors affecting the prognosis of patients with AKI(p <0.05).Conclusion: Serum free carnitine and total carnitine concentrations decreased in patients with acute kidney injury,while the concentrations of medium-and short-chain acylcarnitine increased in those with normal renal function.The more severe the renal injury was,the lower the serum free carnitine and total carnitine were.The survival rate of the patients was negatively correlated with the serum free carnitine and totalcarnitine.The length of hospital stay was associated with serum free carnitine and total carnitine,but was not an independent risk factor for the length of hospital stay.To sum up,serum carnitine spectrum changes can reflect the severity and prognosis of acute kidney injury. |
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