连续性肾脏替代治疗对脓毒症急性肾损伤患者NGAL的表达影响及其机制探讨

Effect of CRRT treatment on expression of NGAL in patients with sepsis associated acute kidney injury and its mechanism

目的通过观察连续性肾脏替代治疗（CRRT）对脓毒症急性肾损伤（AKI）患者中性粒细胞明胶酶相关脂质运载蛋白（NGAL）表达水平的影响，探讨CRRT疗效评价方法及其可能的机制。方法ICU确诊脓毒症AKI患者38例，分为常规药物治疗组（A组，n=17）和CRRT组（B组，n=21）。两组患者均在确诊脓毒症AKI后立即予以规范的抗脓毒症治疗（按2008SSC标准），B组在规范治疗的基础上同步行CRRT24h。两组均监测治疗0h、12h、24h及48h血肌酐（sCr）、血NGAL（sNGAL）、尿NGAL（uNGAL）水平，同时监测B组CRRT废液中NGAL的表达水平。记录28d病死率。选取20例健康志愿者作对照（c组，n=20）。结果A组sNGAL水平在治疗后12h、24h、48h均显著高于治疗前（P均〈0．05），而B组治疗前后改变不明显（P〉0．05）；A组治疗前后uNGAL水平改变不明显（P〉0．05），B组在CRRT治疗后uNGAL水平24h、48h较治疗前显著下降（P〈0．05）；B组sNGAL、uNGAL水平在治疗后12h、24h、48h均显著低于A组同期水平（P均〈0．05）；B组超滤液中未检测到NGAI。表达；A组28d病死率显著高于B组（P〈0．05）；A、B两组sNGAL、uNGAL的表达水平在治疗前后均显著高于C组（P〈0．05）。结论CRRT能降低uNGAL的表达，改善AKI预后，但并非通过直接清除血浆NGAL途径。uNGAL水平可作为CRRT疗效判断的可靠指标。

Objective To investigate the mechanism of neutrophil gelatinase - associated li- pocalin（NGAL） changed in patients with septic associated with acute kidney injury （AKI） and treated with continuous renal replacement therapy （CRRT）. Methods 38 septic associated with AKI patients admitted in ICU were divided into conventional drug treatment group （group A, n = 17） and CRRT group （ group B, n = 21 ）. Both groups were treatment with standard anti - sepsis （ consult 2008 SSC）, and Group B were accepted CRRT further. The levels of serum creatinine （ sCr）, serum neutrophil gelatinase - associated lipocalin （sNGAL） and urinary neutrophil gelatinase - associated lipocalin （ uN- GAL） were measured at 0, 12, 24, 48 hours time point after the treatment before mentioned, the levels of NGAL expressed in ultra filtrate of CRRT were measured in group B, too. Moreover, we collected Twenty healthy volunteers as the control group （ group C, n = 20）. Results The level of sNGAL was increased after treatment in the group A （ P 〈 0.05 ）, but did not change obviously in group B （ P 〉 0. 05）. The level of uNGAL in group B were decreased significantly in 24 h, 48 h compared to 0 h（P 〈 0.05 ）, but there was no change in group A（ P 〉 0.05 ）. The levels of sNGAL, uNGAL in group B were decreased significantly at 12, 24, 48 hours time point compared to group A at the same time（P 〈 0. 05）. The expression of NGAL was not detected in ultrafihrate of group B. The 28 days mortality of groupA was significantly higher than group B. The levels of sNGAL and uNGAL in group A and B were significantly higher than the group C （P 〈 0.05 ）. Condtmion With CRRT, the expression levels of NGAL were decreased significantly, which could improve the prognosis of AKI. But NGAL was not di- rectly removed from plasma. The level of uNGAL was as a reliable indicator to evaluate the therapeutic effectiveness of CRRT.