尿液检测指标在脓毒症合并急性肾损伤治疗中的应用

Application of the urine test index in the treatment of acute renal injury complicated with sepsis

目的探讨分析尿中性粒细胞明胶酶相关脂质运载蛋白(urinary neutrophil gelatinase associated lipocalin,uNGAL)和尿肾损伤分子-1(urinary kidney injury moleeule-1,uKim-1)表达水平在治疗合并急性肾损伤脓毒症过程中的诊断价值,以便更好地指导临床治疗。方法回顾性分析吉林大学第一医院2014-11至2017-02收治的124例合并急性肾损伤脓毒症患者临床资料,按照治疗方法分为A组(常规治疗组,n=62)和B组[早期连续肾脏替代疗法(continuous renal replacement therapy,CRRT)标准化治疗组,n=62],同时选取同时期健康人群为对照组(n=30)。收集尿液样本,检测两组0 h、12 h、24 h、48 h及对照组0 h的uNGAL、uKim-1水平。结果 A、B两组0 h的uNGAL、uKim-1水平均高于对照组同时间点uNGAL、uKim-1值,差异均具有统计学意义(P<0.05);经过治疗,A组uKim-1水平,B两组的u NGAL和uKim-1水平与同组0 h比较,均有不同程度的改善(P<0.05);B组12 h、24 h、48 h的u NGAL,48 h的u Kim-1值明显低于A组相同时间点值,差异均有统计学意义(P<0.05)。结论早期CRRT标准化治疗能改善机体uNGAL和uKim-1水平,提示uNGAL和uKim-1可作为评价临床治疗合并急性肾损伤脓毒症效果的重要生物指标。

Objective The objective of this study was to investigate the value of urinary neutrophil gelatinase associated lipocalin （uNGAL） and urinary kidney injury molecule-1 （uKim-1） expression level in the diagnosis of acute kidney injury complicated with sepsis and to provide clinical guidance for treatment. Methods A total of 124 cases with acute kidney injury sepsis treated in The First Hospital of Jilin University between November 2014 and February 2017 were retrospectively analyzed. Based on the methods of treatment, they were divided into group A （conventional treatment group） and group B （early continuous renal replacement therapy standardized treatment group）, with 62 cases in each group. The control group was comprised of 30 healthy individuals. The urine samples were collected. The level of uNGAL and uKim-1 of two groups at the time point of 0 h, 12 h, 24 h, 48 h and of the control group at the time point of 0 h were analyzed. Results The uNGAL and uKim- 1 levels at the time point of 0 h of A and B groups were higher than that of the control group （P〈0.05）; after treatment, uKim- 1 levels of group A, the uNGAL and uKim- 1 levels of group B were improved to different degree compared to the level at 0 h within their own group （P〈0.05）; the uNGAL level of group B at the time point of 12 h, 48 h, 24 h, and the uKim-1 level of group A at the time point of 0 h was lower than that of group A at the same time point, and the differences were statistically significant （P〈O.05）. Conclusions Early Continuous Renal Replacement Therapy （CRRT） standardization treatment can improve the uNGAL and uKim-1 levels, thus uNGAL and uKim- 1 can be used as biological indicators to evaluate the treatment effectiveness of sepsis associated with acute kidney injury.