基于血清胱抑素C水平的脓毒症性急性肾损伤患者连续肾替代疗法启动时机研究

Starting Time of Continuous Renal Replacement Therapy Based on the Serum Cystatin C Level in Patients with Sepsis-induced Acute Kidney Injury

目的评估胱抑素C作为脓毒症性急性肾损伤(SAKI)患者连续肾替代治疗(CRRT)启动时机依据的价值。方法选取2013年1月—2015年1月于广西医科大学第一、二附属医院ICU治疗的SAKI患者65例为研究对象。收集患者临床资料,采用急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官衰竭估计评分(SOFA)评价患者疾病严重程度。监测行CRRT前降钙素原、血肌酐、胱抑素C水平。根据胱抑素C水平开始升高至行CRRT的间隔时间,将患者分为A组(<48 h,29例)、B组(48~72 h,17例)和C组(>72 h,19例)。结果各组性别、尿量、平均动脉压、机械通气比例、使用血管活性药物比例、合并器官衰竭数、APACHEⅡ评分、SOFA、降钙素原、血肌酐、胱抑素C水平比较,差异均无统计学意义(P>0.05)。各组年龄比较,差异有统计学意义(P<0.05);其中A组年龄低于B、C组(P<0.05)。各组住院病死率比较,差异无统计学意义(P>0.05)。各组肾功能恢复率比较,差异有统计学意义(P<0.05),其中,A组肾功能恢复率高于B、C组(P<0.016)。多因素Logistic回归未发现胱抑素C水平开始升高至行CRRT的间隔时间是SAKI患者肾功能恢复的影响因素[b=0.113,OR=1.120,95%CI(0.482,2.603)]。结论以胱抑素C为启动CRRT的指标,在胱抑素C水平升高48 h内行CRRT可能会提高SAKI患者的肾功能恢复率,该结论尚需进一步证实。

Objective To evaluate the value of serum Cys C as the indicator of implementing continuous renal replacement therapy（CRRT） in patients with sepsis-induced acute kidney injury（SAKI）.Methods We retrospectively studied the clinical data of 65 patients with SAKI treated in the ICU,the First Affiliated Hospital ,and the Second Affiliated Hospital,Guangxi Medical University from January 2013 to January 2015.Acute physiology and chronic health evaluationⅡ（APACHEⅡ） and sepsis-related organ failure assessment（SOFA） were used to assess the severity of disease.The serum procalcitonin（PCT）,creatinine and Cys C levels were measured before the starting of CRRT.According to the duration between Cys C starting to elevate and the starting time of CRRT,these patients were divided into three groups：group A（〈48 h,29 cases）,group B（48-72 h,17 cases）,and group C（〉72 h,19 cases）.Results The groups had no significant differences in gender,urine volume,mean arterial pressure（MAP）,proportion of patients with mechanical ventilation,proportion of patients with vasoactive drugs treatment,number of failing organs,APACHEⅡscore,SOFA score,PCT,serum creatinine,and Cys C（P〉0.05）.Significant difference in age existed among the three groups,specifically,the patients in group A were younger than those in group B and C（P〈0.05）.The in-hospital mortality rate showed no substantial difference among the groups（P〉0.05）.The rate of renal function recovery differed significantly among the groups（P〈0.05）,specifically,it was significantly higher in group A than in the other two groups（P〈0.016）.Multivariate Logistic regression analysis found that,the duration between Cys C starting to elevate and the starting time of CRRT was not significantly associated with the renal function recovery in patients with SAKI〔b=0.113,OR=1.120,95%CI（0.482,2.603）〕.Conclusion It needs to be further confirmed that starting CRRT treatment in patients with SAKI within 48 h after the elevating of Cys C level could increase the rate of renal function recovery.