KIM-1在心肾综合征不同利尿剂合用中的指导价值

Guiding role of KIM-1 in the using of different types of diuretics in patients with cardiorenal syndrome

目的探讨肾脏损伤分子1(KIM-1)在指导心肾综合征患者袢利尿剂与噻嗪类利尿剂合用是否有利于增强利尿效果和保护肾功能。方法将75例心肾综合征患者随机分为两组,对照组35例依据体重+NYHA心功能分级进行用药,实验组40例依据尿液KIM-1水平指导用药,测量连续最低药量维持1个月后血清肌酐、胱抑素C和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿液KIM-1的变化,并比较两组并发症发生率。结果使用利尿剂前至开始使用最低药量维持时,两组血清肌酐、胱抑素C、NGAL和尿液KIM-1水平均有所下降,其中实验组上述指标下降程度尤为明显,与对照组比较差异有统计学意义(P<0.05),连续最低药量维持1个月后,指导组血清肌酐、胱抑素C、NGAL和尿液KIM-1均明显下降,且均明显低于对照组,差异有统计学意义(P<0.05);实验组低血钾和脱水发生率低于对照组,但差异无统计学意义(P>0.05)。结论根据KIM-1水平调整袢利尿剂与噻嗪类利尿剂合用剂量有利于增强心肾综合征患者的利尿效果,更有利于患者肾功能的保护。

Objective To explore the guiding role of kidney injury molecule 1 （KIM-1） for using of loop diuretics combined with thiazide diuretics in patients with cardiorenal syndrome, and evaluate the diuretic and renal protection effects. Methods 75 cases of cardiorenal syndrome patients in our hospital were randomly divided into two groups;the treatment for the control group was based on the weight ＋ NYHA heart function classification to guide medication; treatment for experimental group was based on the urine KIM-1 level to guide medication.Serum creatinine,cystatin C, NGAL and KIM-1 levels in two groups after using the lowestdose and retained for 1 month were compared, and the complications were also compared too. Results The serum creatinine, cystatin C, NGAL and urinary KIM-1 levels at the time of start using lowest dose for maintenance were decreased when compared with those before treatment; the decreases in the experiment group were significantly lower than those in control group （P〈0.05）. Serum creatinine,cystatin C, NGAL and urine KIM-1 levels of the experimental group after using the lowest dose for 1 month were significantly lower than those of control group（P〈0.05）. The hypokalemia and dehydration rate of the experimental group were also lower than those of control group, but the difference was not significant （P〉0.05）. Conclusion Using KIM-1 level to guide theusing of loop diuretics combined with thiazide diuretics could strengthen diuretic effect and protection of renal function in patients with cardiorenal syndrome.