脓毒症急性肾损伤与免疫功能的相关性研究

A correlation study between septic acute kidney injury and immune function

目的 探讨脓毒症急性肾损伤（SAK（I）与机体免疫状态之间相关性,为临床对脓毒症急性肾损伤可预见性的诊断、处理提供依据.方法 采用回顾性研究方法,以北京协和医院急诊监护室2013年1月至2014年9月期间收治的91例成人脓毒症患者为研究对象,根据是否合并有继发性免疫缺陷病（SID）分为免疫缺陷组46例和对照组45例;并根据2012年“改善全球肾脏病预后组织”（KDIGO）指南确立的急性肾损伤诊断标准及分期,将两组的SAKI患者分为非SAKI组（16/23例）、KDIGO-1期组（15/13例）、KDIGO-2期组（11/1例）、KDIGO-3期组（4/8例）.对两组SAKI各期发病率、合并SAKI患者的肾功变化及病情进展速度进行比较.结果 免疫缺陷组与对照组在KDIGO-2期发病率差异具有统计学意义（23.9％vs.2.2％,x2=0.321,P=0.002）,KDIGO-1期及3期发病率比较无统计学意义（1期：32.6％vs.29.8％,x2=0.040,P=0.701;3期：8.7％vs.17.8％,x2=-1.805,P=0.200）.两组中SAKI患者在△Scr、△eGFR等肾功指标变化、用患者出现SAKI天数及发展至SAKI最严重期天数所表达的病情进展速度比较差异无统计学意义（P＞0.05）.结论 继发性免疫缺陷病患者脓毒症急性肾损伤严重程度较正常患者无显著差异.免疫应答过程中炎症介质所导致的肾损伤可能不是脓毒症急性肾损伤的主要机制.

Objective To explore the correlations between septic acute kidney injury （SAKI） and immune condition and provide the clinical basis of predictable diagnosis and treatment in patients with SAKI.Methods Patients diagnosed with sepsis admitted to department of emergency intensive care unit of Peking Union Medical College Hospital between January 1st,2013 and September 30th,2014 were retrospectively studied.A total of 91 patients with sepsis were included,and they were divided into secondary immune deficient （SID） group （n =46） or control group （n =45）.According to the diagnostic criteria and stage of the guidelines of Kidney Disease：Improving Global Outcomes 2012 （KDIGO-AKI 2012）,patients in each group were divided into non-SAKI group （n1 =16,n2 =23）、KDIGO-1 group （n1 =15,n2 =13）、KDIGO-2 group （n1 =11,n2 =1） or KDIGO-3 group （n1 =4,n2 =8）.The morbidity of each stage and the renal index along with the progression of SAKI was also compared in patients with SAKI in two groups.Results While there was a significant difference in the morbidity of KDIGO-2 （23.9% vs.2.2%,x2 =0.321,P =0.002） in patients with SAKI between immune deficient group and control group,the morbidity of KDIGO-1 and KDIGO-3 had no significant difference （KDIGO-1：32.6% vs.29.8%,x2 =0.040,P =0.701;KDIGO-3：8.7% vs.17.8%,x2 =-1.805,P =0.200）.There was also no significant difference in the renal index （△Scr、△eGFR） and progression of SAKI （elapsed days from the diagnosis of sepsis to the occurance and most severe stage of SAKI） in patients with SAKI in two groups （P 〉 0.05）.Conclusion There was no significant difference of the severity of septic acute kidney injury in patients with and without secondary immune deficiency.Inflammatory mediators-induced kidney injury in the process of immune response may not be the main mechanism in SAKI.