脓毒性休克患者血浆胱抑素C的改变及早期液体复苏对其影响

Change of cystatin C and effect of early fluid resuscitation in patients with septic shock

目的通过检测血浆胱抑素C(Cystatin C),早期评价肾功能损伤程度,并探讨早期液体复苏对脓毒性休克患者肾功能的影响。方法河北医科大学第四医院ICU自2008年3月1日～2008年11月30日收治的脓毒性休克患者48例为实验组,健康志愿者20例为正常对照组。参照2004年国际脓毒症治疗指南的早期目标导向治疗(EGDT)对脓毒性休克患者进行液体复苏。分别于0、6、24、48 h 4个时间点,用ELISA法测定血浆Cystatin C的浓度,同时记录患者体温、心率、呼吸、平均动脉压及小时尿量和24 h尿量、CVP、APACHEII评分,根据预后再分为死亡组和存活组。结果液体复苏前脓毒性休克患者血浆Cystatin C水平显著高于对照组,P<0.05;24 h血浆Cystatin C水平较液体复苏前显著下降,P<0.05;死亡组血浆Cys-tatin C水平较存活组显著升高,P<0.05。结论脓毒性休克患者血浆Cystatin C水平明显升高,提示存在急性肾损伤;早期充分的液体复苏可以明显改善脓毒性休克患者的肾功能状态;血浆Cystatin C水平与r水平有很好的相关性,能反应患者早期的肾损害,与肾损害程度正相关。

Objective To examine the injury of renal function and explore the effect of ear- ly fluid resuscitation on the renal function of the patients with septic shock by determining cystatin C. Methods The subjects were 48 patients with septic shock admitted to the ICU of our hospital between March 1, 2008 and November 11, 2008. The control group included 20 healthy volun- teers. According to the 2004 international guideline for the treatment of sepsis, fluid resuscitation was conducted through the emplaced deep venous catheter following the early goal directed therapy （EGDT）, once the selected patients were admitted. Blood samples were taken at 0 hour before the fluid loading, and at 6th, 24th, 48th hours after the fluid loading. The plasma cystatin C was de- tected by the ELISA. Meanwhile the temperature, heart rate, respiration rate, mean arterial pres- sure, hourly-and 24 hour urine volume, Scvo2 and the APACHEII score were simultaneously recorded. The subjects were further divided into survival and non-survival groups. Results The plasma cystatin C levels before fluid loading were statistically higher than those of the control group （P 〈 0.05）. The plasma cystatin C levels at 24 h were significantly lower than those before the treatment （P〈O. 05）. The plasma cystatin C level of the non-survival group were statistically high- er than that of the survival group （P 〈 0.05）. Conclusion The elevated plasma concentration of the cystatin C in patients with septic shock indicates the occurrence of AKI. Early and complete flu- id loading may markedly improve the renal function in the studied patients. The plasma cystatin C and Scr are well correlated, but the plasma cystatin C can reflect the damage of the renal function earlier, and the plasma concentration of the cystatin C were positively correlated with damage of the renal function.