肝硬化患者急性肾损伤的分期与临床疗效的关系

Relationship between the stage of cirrhosis complicated with newly developed acute kidney injury and the efficacy of clinical treatment

目的探讨肝硬化初发急性肾损伤(acute kidney injury,AKI)患者的AKI分期与补液扩容为主的综合治疗的疗效关系,探讨AKI分期与尿肾损伤分子-1(kidney injury molecule-1,KIM-1)水平的关系。方法 2014年9月至2017年1月收治肝硬化合并新发AKI患者61例,分为AKI 1期及2~3期,停用利尿剂、血管扩张剂及肾毒性药物,给予补液扩容为主的综合治疗48 h,评价初发AKI时、治疗48 h两个时间点的疗效;采用ELISA方法检测尿KIM-1,分析AKI分期与疗效、尿KIM-1的关系。结果 61例肝硬化初发AKI患者,AKI 1期47例,2~3期14例;治疗48 h后,AKI 1期治疗有效率高于AKI 2~3期(63.8%vs.28.6%,P<0.05);相同AKI分期患者治疗48 h前后血BUN、SCr和尿KIM-1的差异均有统计学意义(P<0.05)。AKI 1期患者对扩容治疗的疗效优于2~3期。AKI 1期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.310,P=0.766);AKI 2~3期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.392,P=0.696)。结论肝硬化初发AKI患者的分期越高,尿KIM-1水平越高;扩容治疗无效组尿KIM-1水平高于有效组。

Objective To investigate the relationships between the stage of cirrhosis complicated with newly devel- oped acute kidney injury （AKI） and the effects of circulatory volume expansion therapy, the level of urinary kidney injury molecule-1 （KIM-1） measured before or after the expansion therapy. Metbods Recruitedffom September, 2009to Janu- ary, 2017, a total of 61 patients with cirrhosis complicated with newly developed AKI were categorized as stage I or stage ]I/HI. Diuretics, vasodilators and medications with nephrotoxicity were discontinued and circulatory volume expansion therapy and intravenous infusion of albumin were applied. Forty-eight hours later, the efficacy of the treatment was ana- lyzed. KIM-lwere examined in urine samples. The relationship of AKI stages with both treatment effects and the level of urinary KIM- 1 were analyzed. Results A total of 61 patients with cirrhosis complicated with newly developed AKI con- sisted of 47 at stage Ⅰ and 14 at stage Ⅱ/Ⅲ. Forty-eight hours after expansion therapy, effective rate was higher in patients of stage I than that of stage Ⅱ/Ⅲ （63.8% vs. 28.6%, P 〈 0.05 ）. There was significant difference in BUN, SCr, KIM- 1 before and after the treatment in the same stage ofAKI（P 〈 0.05）. The efficacy was better in AKI stage Ⅰ than stage Ⅱ/Ⅲ. The levels of urine KIM- 1 in patients at stage Ⅰ and Ⅱ/Ⅲ showed no difference before and after expansion treat- ment （P 〉 0.05）. Conclusion The higher level of KIM- 1 in urine, the more advance the AKI stage. The level of KIM- 1 is higher in treatment ineffective group than in the treatment effective group.