连续性肾脏替代治疗对脓毒症AKI患者尿肾损伤分子-1表达的影响及其机制初步探讨

The expression of kidney injury molecule-1 in the patients with septic acute kidney injury treating with CRRT

目的 通过监测连续性肾脏替代治疗（CRRT）对脓毒症相关性急性肾损伤（AKI）患者尿肾损伤分子-1（uKim-1）表达水平的影响,初步探讨CRRT疗效评价的可靠指标及其机制.方法 ICU确诊为脓毒症AKI患者38例,分为标准抗脓毒症治疗组（A组,n=17）和CRRT组（B组,n=21）.所有脓毒症AKI患者均予以标准规范的药物抗脓毒症治疗（2008 SSC标准）,B组在标准抗脓毒症治疗的基础上予以CRRT 24 h.监测两组患者治疗0、12、24、48 h时间点血肌酐（sCr）、血Kim-1（sKim-1）、uKim-1水平,同时监测B组CRRT废液Kim-1的表达水平,记录28 d患者病死率.从本院体检人群中选取20例体检健康者作为健康对照组（C组,n=20）.结果 A组uKim-1水平在12、24h较0h显著下降（P＜0.05）,48 h与0h比较差异无统计学意义（P＞0.05）;B组uKim-1在CRRT后12、24、48 h较0h显著下降（P＜0.05）,但A、B两组uKim-1同期表达水平比较差异无统计学意义（P＞0.05）;B组超滤液中未检测到Kim-1表达;B组28 d病死率显著低于A组（22.7％ vs 61.2％,P＜0.05）;A、B两组sKim-1水平在治疗前后差异无统计学意义（P＞0.05）,但B组sKim-1水平在治疗后12、24、48 h显著低于A组同期水平（P＜0.05）.结论 CRRT能降低uKim-1的表达水平,但对sKim-1水平影响不显著;CRRT废液中未能检测出Kim-1的表达,uKim-1能更好地反映CRRT对肾功能影响,可作为CRRT疗效判断的可靠指标.

Objective To evaluate the therapeutic effectiveness and to investigate the possible mechanisms of continuous renal replacement therapy （CRRT） in sepsis associated with acute kidney injury （AKI） by observing the changed of kidney injury molecule-1 （Kim-1）,aimed to provide the evidence-based on CRRT with septic AKI in clinical.Methods Thirty eight patients with sepsis associated with AKI admitted in ICU were divided into conventional drug treatment group （group A,n =17） and CRRT group （group B,n =21）.Both groups were treated with standard anti-sepsis （consult 2008SSC）,and Group B was accepted CRRT for 24 hours further.The serum creatinine （sCr）,serum kidney injury molecule-1 （sKim-1） and urinary kidney injury molecule-1 （uKim-1） were measured at the time of points 0,12,24,48 hours before and after the treatment,and the Kim-1 which was expressed in ultra filtrate of CRRT were also measured in group B.The 28-day mortality was also recorded.Moreover,we collected twenty healthy volunteers as the control group （group C,n =20）.Results The level of sKim-1 did not change obviously after treatment in the group A and group B （P ＞ 0.05）.The level of uKim-1 in group A were decreased significantly in 12,24 h compared to 0 h （P ＜ 0.05）,when there was no change in 48 h （P ＞ 0.05）.In group B,the level of uKim-1 were decreased significantly in 12,24,48 h（P ＜0.05）.The expression of Kim-1 was not detected in ultra filtrate of CRRT in group B.The 28-day mortality was significantly higher in group A than in group B.The levels of sKim-1 and uKim-1 were significantly higher in group A and B than in the group C（P ＜ 0.05）.Conclusion uKim-1 was significantly decreased after CRRT,but there was no significant effect on sKim-1.Kim-1 was not detected in ultra filtrate of CRRT.As reliable biomarkers,uKim-1 can been used to reflect the change of renal function in CRRT and evaluate the therapeutic effectiveness.