连续性肾脏替代治疗对脓毒症急性肾损伤患者尿ALR、NHE3及血IL-18的影响

Effect of continuous renal replacement therapy on urine ALR,NHE3 and serum IL-18 in sepsis patients complicated with acute kidney injury

目的分析连续性肾脏替代治疗(CRRT)对脓毒症急性肾损伤患者肝再生增强因子(ALR)、尿Na/H交换体亚型3(NHE3)及白细胞介素-18(IL-18)的影响。方法选取72例脓毒症急性肾损伤患者作为研究对象,随机分为对照组和CRRT组,每组36例。对照组接受标准规范化抗脓毒症治疗,CRRT组在对照组的基础上予CRRT治疗。比较两组患者治疗前后的尿ALR、尿NHE3及血IL-18表达水平,尿量恢复时间、重症监护病房(ICU)住院时间及心血管事件发生率。结果经治疗后,两组患者的尿ALR、尿NHE3及血IL-18水平均显著低于治疗前(P<005),且CRRT组上述指标的水平明显低于对照组,差异均存显著统计学意义(P<001)。治疗后,对照组的白细胞计数、中性粒细胞比例及降钙素原较治疗前显著上升(P<005),而CRRT组的上述指标较治疗前明显下降(P<005),且对照组治疗后各项指标均显著高于CRRT组(P<005)。CRRT组的心血管事件发生率为19.4%,病死率为20.3%,明显低于对照组41.7%的心血管事件发生率和58.9%的病死率(P<005),且CRRT组的尿量恢复时间及ICU住院时间更短(P<005)。通过logistic回归分析,IL-18为患者术后心血管事件发生的独立危险因素(OR=3.545,95%CI=2.134~6.342,P=0.011);ALR(OR=1.028,95%CI=1.046~1.131,P=0.035)、NHE3(OR=1.045,95%CI=1.032~1.142,P=0.023)及IL-18(OR=1.253,95%CI=1.341~2.127,P=0.036)为患者预后的独立预测指标。结论CRRT能明显降低ALR、NHE3及IL-18在脓毒症急性肾损伤患者体内的表达水平,延缓脓毒症急性肾损伤进程,降低心血管不良事件的发生,疗效确切,值得临床推广。

Objective To analyze the effect of continuous renal replacement therapy(CRRT)on urine ALR,NHE3 and serum IL-18 in sepsis patients complicated with acute kidney injury.Methods A total of 72 sepsis patients complicated with acute kidney injury were randomly divided into control group and CRRT group.The control group received standardized antisepsis treatment,and the CRRT group received continuous renal replacement therapy on the basis of standardized antisepsis treatment.The concentrations of urinary ALR,NHE3 and serum IL-18 before and after treatment,the recovery time of urine volume,the duration of ICU hospitalization and the incidence of cardiovascular events were compared between the two groups.Results After treatment,urinary NHE3 ALR,urine and blood IL-18 concentrations in the two groups were all significantly lower than before treatment(P<0.05),and the concentrations of the above indicators in CRRT group were significantly lower than those in the control group(P<0.01).After treatment,the white blood cell count,neutrophil ratio and procalcitonin in the control group were significantly higher than those before treatment(P<0.05),while those in the CRRT group were significantly lower than those before treatment(P<0.05),and those indicators in the control group were significantly higher than those in the CRRT group after treatment(P<0.05).The incidence and mortality of cardiovascular events in CRRT group were 19.4%and 20.3%,which were significantly lower than those in control group(41.7%and 58.9%respectively,P<0.05),and the recovery time of urine volume and ICU hospitalization time in CRRT group were shorter(P<0.05).Logistic regression analysis showed that IL-18 was an independent risk factor for cardiovascular events(OR=3.545,95%CI=2.134-6.342,P=.011).ALR(OR=1.028,95%CI=1.046-1.131,P=0.035),NHE3(OR=1.045,95%CI=1.032-1.142,P=.023)and IL-18(OR=1.253,95%CI=1.341-2.127).P=0.036)was an independent predictor of prognosis.Conclusion Continuous renal replacement therapy can significantly reduce the concentrations of urine ALR,NHE3 and serum IL-18 for sepsis patients complicated with acute renal injury,delay the progression of acute kidney injury in sepsis,reduce the incidence of cardiovascular adverse events.It is effective and worthy of clinical promotion.