内毒素和内皮素-1与急性胰腺炎患者并发急性肾损伤的关系

Association of endotoxin and endothelin-1 with acute kidney injury in patients with acute pancreatitis

目的:探讨内毒素和内皮素-1(endothelin-1,ET-1)与急性胰腺炎(acute pancreatitis,AP)患者并发急性肾损伤(acute kidney injury,AKI)的关系.方法:纳入我院2011-01/2012-07AP并发AKI住院患者52例(病理组)与同期AP无AKI住院患者52例(对照组),收集研究对象临床资料,计算全身炎症反应(systemic inflammatory response,SIRS)评分,并采集血液分析两组生化指标、白细胞计数、降钙素原(procalcitonin,PCT)和ET-1水平.分析比较两组的临床资料和实验室结果.结果:病理组SIRS评分为2.66±0.86,对照组为2.30±1.00,两组均存在全身炎症反应,但差异无统计学意义(t=1.90,P>0.05).病理组PCT和ET-1分别为23.24ng/mL(9.99ng/mL,70.44ng/mL)和7.61pg/mL±2.17pg/mL,高于对照组的0.23ng/mL(0.11ng/mL,0.61ng/mL)(Z=-7.31,P<0.05)和2.34pg/mL±1.28pg/mL(t=4.98,P<0.05).病理组尿素、肌酐、血胱抑素C分别为19.75mmol/L(13.44mmol/L,25.75mmol/L)、344.0mmol/L(281.8mmol/L,450.8mmol/L)、3.09mol/L(2.43mol/L,4.11mol/L),高于对照组4.48mmol/L(3.45mmol/L,7.48mmol/L)、49.4mmol/L(43.8mmol/L,70.6mmol/L)、0.86mol/L(0.69mol/L,1.02mol/L)(Z值分别为-7.69、-8.39和-8.31,P<0.05).病理组和对照组死亡率分别为36.5%和5.8%,好转率分别为21.2%和94.2%(2=141.92,P<0.05).结论:内毒素诱导ET-1表达增加,ET-1强烈收缩肾血管引发肾灌注不足,导致AP患者并发AKI.内毒素和ET-1与AP患者并发AKI关系密切.

AIM： To investigate the association of endotoxin and endothelin-1 with acute kidney injury in patients with acute pancreatitis （AP）.METHODS： Fifty-two AP patients with acute kidney injury and equal number of AP patients without acute kidney injury were enrolled in this study. Blood samples were obtained from all patients for laboratory analysis of liver function, renal function, electrolytes, procalcitonin （PCT） and endothelinq （ET-1）.RESULTS： The SIRS score showed no significant difference between cases and controls （2.66 ± 0.86 vs 2.30 ± 1.00, t = 1.90, P 〉 0.05）,indicating that both groups suffered from systemic inflammatory response. The levels of PCT （23.24 ng/mL vs 0.23 ng/mL, Z = -7.31, P 〈 0.05）, ET-1 （7.61 pg/mL ± 2.17 pg/mL vs 2.34 pg/mL ± 1.28 pg/mL, t = 4.98, P 〈 0.05）, urea （Z = -2.17）, creatinine （Z = -7.69） and cystatin C （Z=-8.39） were significantly higher in cases than in controls. The mortality and improvement rates also differed significantly between cases and controls （36.5% vs 5.8%; 21.2% vs 94.2%, χ^2= 141.92, P 〈 0.05）.CONCLUSION： Endotoxin and ET-1 are closely associated with the development of acute kidney injury possibly by inducing severe renal vasoconstriction.