乌司他丁对脓毒症急性肾损伤肾功能的保护作用

Protective effect of ulinastatin on renal function of patients with sepsis-induced acute kidney injury

目的 观察乌司他丁（UTI）对脓毒症急性肾损伤患者尿液中性粒细胞明胶酶相关载脂蛋白（NGAL）、肾损伤分子-1（Kim-1）及血浆胱抑素C（Cys C）、血浆白细胞介素-18（IL-18）的影响及肾功能保护作用.方法 62例脓毒症确诊合并急性肾损伤的患者随机分为2组,其中对照组（C组,n=31）接受常规的常规治疗,包括：早期复苏、监测乳酸指导补液、抗菌药物应用、机械通气、血液净化,联用乌司他丁组（UTI组,n=31）在接受对照组常规治疗方法的基础上加用乌司他丁,于治疗前和治疗后第8天测定尿液NGAL、Kim-1及血浆Cys C、IL-18.结果 C组治疗后NGAL（3.43±0.35） μg/L、Kim-1 （5.37 ±0.30） μg/L、Cys C （9.29±0.28） mg/L及IL-18水平（136.87±6.43） ng/L与治疗前[NGAL（0.92 ±0.10） μg/L、Kim-1（4.13±0.22） μg/L、Cys C （3.53±0.25） mg/L及IL-18水平（83.37±7.65）ng/L]比较差异均有统计学意义（P＜0.01）,而UTI组差异更为明显[治疗后NGAL（2.71±0.22） μg/L、Kim-1（4.79±0.23） μg/L、Cys C （7.29±0.33） mg/L及IL-18水平（110.28±6.86） ng/L比治疗前NGAL（0.99 ±0.37） μg/L、Kim-1 （4.21±0.25） μg/L、Cys C（3.50±0.25） mg/L及IL-18水平（84.27±7.51） ng/L,P＜0.01].结论 联用乌司他丁能显著降低NGAL、Kim-1、Cys C及IL-18水平,乌司他丁对脓毒症所致急性肾损伤具有一定的肾脏保护作用.

Objective To evaluate the protective mechanism and efficacy of ulinastatin （UTI） on leveld of urine neutrophil gelatinase associated lipocalin （NGAL）,urine kidney injury molecule-1 （Kim-1）,plasma vystatin C （Cys C）,plasma interleukin-18 （IL-18） and kidney organ function in patients with sepsis-induced acute kidney injury.Methods Sixty-two patients with sepsis-induced acute kidney injury were divided into control group （group C,n =31） and UTI treatment group （group UTI,n =31） according to the random double blind method.The routine group was given routine treatment,including early recovery,monitoring lactate guiding rehydration,antibiotics application,mechanical ventilation,blood purification.On the basis of conventional treatment,the UTI group was given 300 000 U UTI dissolved in in 50 ml 0.9% normal saline,i.v.,twice daily for 7 days.Urine NGAL,urine Kim-1,plasma Cys C,and plasma IL-18 were determined before and at 8th day after the treatment.Results After treatment,NGAL [（3.43±0.35） μg/L],Kim-1 [（5.37 ±0.30） μg/L],Cys C [（9.29 ±0.28） mg/L] and IL-18 [（136.87 ±6.43） ng/L] in group C were significantly different from those before treatment [NGAL （0.92 ±0.10） μg/L,Kim-1 （4.13 ±0.22） μg/L,Cys C （3.53 ±0.25） mg/L and IL-18 （83.37 ± 7.65） ng/L] （P 〈 0.01）.The UTI group had more significant difference [after treatment,NGAL （2.71 ± 0.22） μg/L,Kim-1 （4.79 ±0.23） μg/L,Cys C （7.29±0.33） mg/L and IL-18 （110.28 ± 6.86） ng/L vs.before treatment,NGAL （0.99 ± 0.37） μg/L,Kim-1 （4.21 ± 0.25） μg/L,Cys C （3.50±0.25） mg/LandIL-18 （84.27±7.51） ng/L,P〈0.01].Conclusion Combined use of UTI can significantly reduce the NGAL,Kim-1,Cys C and IL-18 levels.UTI has beneficial effects on the protection of kidney in patients with sepsis-induced acute kidney injury.