乌司他丁联合高容量血液滤过治疗急性肾损伤临床疗效及对尿NGAL、KIM-1和L-FABP的影响

Effect of ulinastatin combined with high volume hemofiltration in the treatment of acute renal injury and its effect on urine NGAL,KIM-1 and L-FABP

目的 观察乌司他丁联合高容量血液滤过治疗急,性肾损伤的临床疗效及对尿中性粒细胞明胶酶脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)和肝型脂肪酸结合蛋白(IL-FABP)的影响。方法 收集2014年5月—2017年9月广西医科大学第一附属医院肾内科收治的脓毒症并AKI患者92例的临床资料作回顾性分析,并根据治疗方式的不同分为观察组、对照组,每组46例。对照组给予高容量血液滤过治疗,观察组在对照组的基础上联合乌司他丁治疗,比较2组患者治疗前后的血尿素氮、血肌酐及尿NGAL、KIM-1、L-FABP水平、血清炎性因子及少尿期持续时间。结果 治疗后2组患者血尿素氮、血肌酐水平均较治疗前下降(P均=0.001),且观察组较对照组下降更明显(t=10.688、12.179,P均=0.001);治疗后2组患者尿NGAL、KIM-1、L-FABP水平均较治疗前下降(P均=0.001),且观察组较对照组下降明显(t=5.109、6.153、7.797,P均=0.001);治疗后2组血TNF-α、IL-6、IL-8水平均有明显改善(P均=0.001),与对照组比较观察组患者治疗后TNF-α、IL-6、IL-8明显改善(t=5.509、6.923、3.148,P均=0.001),IL-10水平治疗前后及组间比较均无显著差异(P>0.05),观察组少尿期持续时间短于对照组(t=10.510,P=0.004)。结论 乌司他丁联合高容量血液滤过治疗脓毒症伴AKI患者临床疗效显著,可有效地改善其肾功能,降低尿NGAL、KIM-1、L-FABP水平。

Objective To observe the clinical effect of ulinastatin combined with high volume hemofiltration in the treatment of acute renal injury and its effect on urinary NGAL, KIM-1 and L-FABP. Methods From May 2014 to September 2017,92 patients with sepsis associated with AKI were collected from the Department of Blood purification, first affiliated hospital of Guangxi Medical University for retrospective analysis,and patients were divided into observation group and control group according to the different treatment methods. There were 46 cases in each group. The control group was treated with high volume hemofiltration,and the observation group was treated with ulinastatin on the basis of the control group. The levels of blood urea nitrogen,serum creatinine,NGAL,KIM-1,L-FABP,inflammatory factors and the duration of oliguria were compared between the two groups before and after treatment. Results After treatment,the levels of blood urea nitrogen and serum creatinine in both groups were significantly lower than those before treatment（ P =0.001）. The levels of blood urea nitrogen and serum creatinine in the observation group were significantly lower than those in the control group （ t =10.688, t =12.179, P =0.001, P =0.001）. After treatment, the levels of NGAL, KIM-1 and L-FABP in the two groups were significantly lower than those before treatment （ P =0.001）, and the levels of those in the observation group were significantly lower than those in the control group （ t =5.109, t =6.153, t =7.797, P =0.001, P =0.001, P =0.001）. After treatment,the levels of TNF-α, IL-6 and IL-8 were significantly improved in the two groups （ P =0.001） and the observation group had a better improvement in those indicators （ t =5.509, t =6.923, t =3.148, P =0.001, P =0.001, P =0.001）. There was no significant difference in the levels of IL-10 in the two groups before and after treatment （ t =0.601, t =0.183, t =0.137, P =0.275, P = 0.428, P =0.446）. The duration of oliguria in the observation group was shorter than that in the control group （ t = 10.510 , P = 0.004 ）. Conclusion Ulinastatin combined with high volume hemofiltration is effective in the treatment of septic patients with AKI. It can effectively improve renal function and decrease the levels of NGAL, KIM-1 and L-FABP.