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目的探讨尿肾损伤分子-1(u Kim-1)及尿中性粒细胞胶原酶相关脂质运载蛋白(u NGAL)水平在评价脓毒症急性肾损伤(AKI)治疗效果中的应用价值。方法选择82例脓毒症AKI患者,根据治疗方式的不同分为Ⅰ组(常规药物治疗,46例)和Ⅱ组(早期CRRT标准化治疗,36例),同时选择30例健康志愿者作为对照组。检测两组患者0、12、24、48 h及对照组0 h的u Kim-1及u NGAL;检测两组患者各个时间点的体温、白细胞计数(WBC)、中性粒细胞比率(NE)、动脉血乳酸水平(LAC)及降钙素原(PCT)水平,并观察记录两组患者急性生理学及慢性健康评分(APACHEⅡ)及28 d的病死率。结果相同时间点,与对照组比较,Ⅰ、Ⅱ组患者0 h的u Kim-1及u NGAL水平显著升高(P<0.05);与Ⅰ组比较,Ⅱ组48 h的u Kim-1及12、24、48 h的u NGAL显著降低(P<0.05)。不同时间点组内比较,Ⅰ组12、24 h的u Kim-1显著低于0 h(P<0.05),Ⅱ组12、24、48 h的u NGAL及u NGAL水平显著低于0 h(P<0.05)。相同时间点,与Ⅰ组比较,Ⅱ组12、24、48 h的体温、WBC、NE、LAC及24、48 h的PCT及APACHEⅡ显著下降(P<0.05)。不同时间点组内比较中,Ⅰ组24、48 h的体温、PCT、APACHEⅡ,12 h的WBC、NE,12、24、48 h的LAC均与0 h比较差异有统计学意义(P<0.05)。Ⅱ组12、24、48 h体温、WBC、NE、LAC及24、48 h的PCT及APACHEⅡ均与0 h比较差异有统计学意义(P<0.05)。Ⅱ组患者28 d的病死率(22.2%)显著低于Ⅰ组(56.5%,P<0.01)。结论早期CRRT标准化治疗脓毒症AKI能够显著降低u Kim-1及u NGAL的水平,同时,u Kim-1及u NGAL的水平也可作为CRRT疗效评估的重要生物学指标。
Objective To investigate the value of urinary renal injury molecule-1 (u Kim-1) and urinary neutrophil collagenase-associated lipocalin (u NGAL) in the evaluation of the therapeutic effect of acute kidney injury (AKI) in sepsis. Methods Eighty-two patients with sepsis-induced AKI were divided into group Ⅰ (n = 46) and group Ⅱ (initial standard CRRT, n = 36) according to different treatment methods. Thirty healthy volunteers were selected as control group . The u Kim-1 and u NGAL at 0, 12, 24 and 48 h in the two groups and 0 h in the control group were detected. The body temperature, white blood cell count (WBC), neutrophil ratio (NE) , Arterial blood lactate level (LAC) and procalcitonin (PCT). The acute physiology and chronic health score (APACHEⅡ) and the mortality rate of 28 days were recorded. Results Compared with the control group, the levels of u Kim-1 and u NGAL in group Ⅰ and group Ⅱ at 0 h were significantly increased (P <0.05). Compared with group Ⅰ, the expression of u Kim-1 and u NGAL at 48 h in group Ⅱ U NGAL at 12, 24 and 48 h decreased significantly (P <0.05). The levels of u-NG-1 and u-NGAL in group I at 12, 24, and 48 h were significantly lower than those at 0 and 24 h (P <0.05) P <0.05). At the same time point, the body temperature, WBC, NE, LAC, PCT and APACHEⅡ at 24 h, 48 h and 48 h significantly decreased in group Ⅱ (P <0.05) compared with group Ⅰ. The differences of body temperature at 24,48 h, PCT, APACHEⅡ, WBC at 12 h, LAC at 12, 24 and 48 h in group Ⅰ were significantly different from 0 h at different time points (P <0.05 ). The body temperature, WBC, NE, LAC, PCT and APACHEⅡ at 24 h, 48 h and 48 h in group Ⅱ were significantly different from those at 0 h (P <0.05). The mortality of patients in group Ⅱ at 28 days (22.2%) was significantly lower than that in patients in group Ⅰ (56.5%, P <0.01). Conclusions Early standard CRRT treatment of sepsis AKI can significantly reduce the levels of u Kim-1 and u NGAL. Meanwhile, the levels of u Kim-1 and u NGAL can also be used as important biological indicators for the evaluation of CRRT efficacy.