乌司他丁治疗蜂蜇伤后急性肾损伤的救治分析

Ulinastatin Against Acute Kidney Injury Following Wasp Stings

目的研究乌司他丁对蜂蜇伤后急性肾损伤(AKI)的疗效及其机制。方法将我科59例患者随机分为对照组(29例)和治疗组(30例),两组给予常规治疗,治疗组在此基础上加用乌司他丁,疗程7 d。观察两组患者死亡率和痊愈率、少尿期持续时间,并观察治疗前和治疗7 d后急性生理学与慢性健康状况评分(APACHE)Ⅱ、血肌酐(Scr)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、血浆肿瘤坏死因子(TNF)α、白介素(IL)-1β和IL-10的水平。结果两组患者死亡率比较,差异无统计学意义(P>0.05),治疗组痊愈率高于对照组(93.1%vs.71.4%,P=0.041),少尿期持续时间治疗组短于对照组〔(21.8±2.7)d vs.(24.8±2.6)d,P=0.0001〕。治疗前两组患者APACHEⅡ、Scr、NAG、TNF-α、IL-1β和IL-10水平差异无统计学意义(P>0.05);治疗7 d后,治疗组APACHⅡ〔(9.46±1.43)vs.(11.04±1.84)〕、Scr〔404.3(366.4,470.0)vs.522.4(438.9,574.7)μmol/L〕、NAG〔(40.77±10.87)vs.(49.49±16.23)U/L〕、TNF-α〔(112.62±32.37)vs.(141.76±53.44)μg/L〕和IL-1β〔(18.01±6.25)vs.(22.04±5.17)pg/ml〕水平均较对照组低,差异有统计学意义(P<0.05),IL-10水平较对照组高〔(75.35±12.38)vs.(68.56±11.01)pg/ml〕,差异有统计学意义(P<0.05)。结论乌司他丁通过减轻肾小管损伤、下调TNF-α、IL-1β水平和上调IL-10水平,减轻毒蜂蜇伤后AKI。

Objective To study the effect of ulinastatin on acute kidney injury（AKI） and its mechanism following wasp stings.Methods Fifty-nine patients were divided randomly into groups control（n=29） and treatment（n=30）.Two groups were treated with conventional therapy,but treatment group with additional ulinastatin injection.Mortality,recovery rates,duration of oliguria observed,and the scores of Acute Physiology and Chronic Health Evaluation（APACHE） II,levels of serum creatinine（scr）,urinary N-acetyl-β-glucosaminidase（NAG）,tumor necrosis factor-α（TNF-α）,interleukin（IL）-1β and IL-10 compared between 2 groups before treatment and 7 days after.Results No significant difference was noted in mortality between 2 groups（P0.05）.Recovery rate was higher in group treatment than in control（93.1% vs.71.4%,P=0.041）,and duration of oliguria shorter（（21.8±2.7）vs.（24.8±2.6）d,respectively,P=0.0001）.There was not significant difference in APACHE Ⅱ,Scr,NAG,TNF-α,IL-1β,IL-10 between 2 groups before treatment（P0.05）.And 7 d after,treatment group were lower than control in APACH Ⅱscores（9.46±1.43）vs（11.04±1.84）,Scr（404.3（366.4,470.0）vs.522.4（438.9,574.7）μmol/L）,NAG（（40.77±10.87）vs.（49.49±16.23）U/L）,TNF-α（（112.62±32.37）vs.（141.76±53.44）μg/L） and IL-1β（（18.01±6.25）vs.（22.04±5.17）pg/ml）,the difference was significant（P0.05）,and higher in IL-10（（75.35±12.38）vs.（68.56±11.01）pg/ml,P0.05）.Conclusion Ulinastatin can alleviate AKI following wasp stings by reducing renal tubule damage,down-regulating TNF-α and IL-1β and up-regulating IL-10.