对重症急性胰腺炎相关急性肾损伤的诊断认识

Understanding of diagnosis of acute kidney injury associated with severe acute pancreatitis

急性肾损伤(AKI)是重症急性胰腺炎(SAP)的一种常见且严重的并发症,也是危重症、脓毒症患者病死率升高的重要标记。SAP导致的AKI与急性炎症反应综合征、低氧血症、胰酶释放后损伤肾脏微循环、腹腔内高压或低血容量导致的肾脏灌注压降低等因素相关,内毒素和反应性氧化物同样担当重要角色。虽然对SAP及AKI的认识不断进步,但相关诊断却未同步发展,导致在SAP相关AKI诊断上存在争议。本文对SAP相关AKI在诊断方面的认识进行探讨。

Acute kidney injury （AKI） is a common, serious complication of severe acute pancreatitis （SAP）, as well as an important indication of increased mortality in critical and sepsis patients. AKI due to SAP can be resulted from inflammatory reaction syndrome, hypoxemia, impaired renal microcirculation following the release of pancreatic amylase, and decreased renal perfusion pressure due to intraabdominal hypertension or hypovolemia. Endotoxins and reactive oxygen species （ROS） also play an important role in the pathophysiology of SAP and AKI. Although with the unceasing advancement of knowledge about SAP and AKI, their diagnostic criteria do not keep pace with the development, which results in the controversies on the diagnosis of AKI associated with SAE This paper tries to discuss the diagnostic knowledge on the AKI associated with SAE