不同生物学标志物对感染性急性肾损伤肾脏替代治疗的评价分析

Evaluation of biological makers for necessity of renal replacement therapy for infective acute kidney injury patients

目的研究不同生物学标志物对感染性急性肾损伤患者是否接受肾替代治疗的评价分析,为临床诊断治疗提供依据。方法选取2010年1月-2013年1月ICU收治的全身感染患者中24h内出现急性肾损伤患者51例作为研究对象,治疗组17例和非替代治疗组34例,观察两组患者在接受肾脏替代治疗前的炎症指标,分析上述指标对感染性急性肾损伤患者接受肾脏替代治疗的评价作用。结果替代治疗组WBC、PCT、uNGAL分别为(15.13±1.12)×109/L、(5.69±0.88)ng/ml、(934.55±112.43)ng/ml,非替代组分别为(10.05±1.88)×109/L、(3.43±0.31)ng/ml、(306.74±125.41)ng/ml,两组比较差异有统计学意义(P<0.05);替代治疗组Lac为(2.2±0.4)mmol/L,非替代组为(4.0±0.7)mmol/L,两组比较差异有统计学意义(P<0.05);而血流动力学指标HR、MAP、PaO2/FiO2、sNGAL、uKIM-1、uIL-18浓度无显著差异。结论炎症指标白细胞计数、降钙素原、组织器官灌注指标血乳酸和尿中性粒细胞胶原酶相关脂质运载蛋白,可以作为评价和预测感染性急性肾损伤患者是否接受肾脏替代治疗的指标。

OBJECTIVE To determine whether the infective acute kidney injury patients receive the renal replacement therapy or not through evaluation of different biological markers so as to provide guidance for the clinical diagnosis and treatment.METHODS A total of 51patients with systemic infections,who were treated in the ICU from Jan 2010to Jan 2013and in whom the acute kidney injury occurred within 24hours,were enrolled in the study,then the subjects were divided into the renal replacement therapy group with 17cases and the non-replacement therapy group with 34cases according to the condition and treatment approach;the roles of the above indicators in guiding the renal replacement therapy for the infectious acute kidney injury patients were evaluated. RESULTS The WBC,PCT,and uNGAL were respectively 15.13±1.12,（5.69±0.88）ng/ml,and（934.55± 112.43）ng/ml in the renal replacement therapy group and were respectively 1 0.05±1.88,（3.43±0.31）ng/ml, and（306.74±125.41）ng/ml in the non-replacement therapy group,the differences between the two groups were significant（P〈0.05）.The Lac was（2.2±0.4）mmol/L in the renal replacement therapy group,（4.0±0.7） mmol/L in the non-replacement therapy group,the difference between the two groups was significant（P〈0.05）. However,there was no significant difference in the HR,MAP,PaO2/FiO2,sNGAL,uKIM-1,or uIL-18concentration.CONCLUSIONThe WBC,PCT,Lac,and uNGAL can serve as the indicators to determine whether the infectious acute kidney injury patients should receive the renal replacement therapy.