连续性血液净化对于脓毒症早期血管内皮通透性标志物Ang-1及SDC-1的影响

Effect of CRRT on Ang-1 and SDC-1 in Acute Kidney Injury in the Early Stage of Sepsis

目的:探讨连续性血液净化(Continuous Renal Replacement Therapy, CRRT)对脓毒症急性肾损伤(acute kidney injury, AKI)内皮细胞通透性的影响。方法:本研究纳入了2015年12月~2016年12月入住我院明确诊断为脓毒症合并AKI患者共计29例。所有入选患者随机分为对照组和实验组。对照组给予常规脓毒症集束化治疗,试验组在常规脓毒症集束化治疗的基础上给予CRRT治疗。应用酶联免疫吸附测定(ELISA)技术,检测脓毒症AKI的患者血浆血管生成素-1 (Angiopoietin-1, Ang-1)和多糖包被标志物多配体聚糖-1 (Syndecan-1, SDC-1)浓度水平,结合患者的临床指标的变化水平,观察CRRT对改善脓毒症AKI内皮细胞通透性的作用。结果:对照组与试验组的APACHE II评分、SOFA评分不具有统计学意义(P 】0.05);与对照组相比,治疗0小时对照组Ang-1浓度与试验组相比无统计学差异(P = 0.121),4小时及12小时检测Ang-1浓度显著高于对照组,且存在统计学差异(P 【0.05);试验组SDC-1浓度在0小时、4小时、12小时均不具有统计学差异,但是,与对照组相比,试验组4小时、12小时的SDC-1的浓度呈下降趋势;对照组和试验组的治疗12小时的单位体重液体入量具有统计学意义(P 【0.05)。结论:CRRT对于脓毒症AKI的内皮细胞通透性有改善作用,早期开展CRRT可以优化患者的液体管理。

Objective: To observe the improvement of continuous renal replacement therapy (CRRT) on endothelial permeability in septic acute kidney injury patients. Methods: We included patients with septic AKI defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI and sepsis and by the absence of other clear and established, non-sepsis-related (e.g. radiocontrast, other nephrotoxins) causes of AKI when admitted to the intensive care unit (ICU) from December 2015 to December 2016, totally 29 cases. All patients were randomly divided into control group and treatment group. The Control group was provided with the sepsis bundle therapy and continue renal replacement therapy (CRRT) was initiated in the treatment group on the basis of the sepsis bundle therapy. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of Ang-1 and SDC-1 in plasma of patients with AKI. The effect of CRRT on the improvement of permeability was observed in combination with the changes of clinical parameters. Results: Patients were similar in critical condition. Compared with the control group, the concentrations of Ang-1 of treatment group at the time of 4th h and 12th h are statistically significant (P values are respectively 0.003 and 0.019). Compared with the control group, the concentration of SDC-1 of the treatment group at the time of 0 h, 4th h and 12th h are not statistically significant. P values are respectively 0.715, 0.531 and 0.377, but the concentrations of SDC-1 at the time of 4th h and 12th h are downtrend. Accumulated fluid intake during 12 h per weight are statistically significant (P = 0.023) between control and treatment group. Conclusion: CRRT can improve the permeability of endothelial cells and optimize fluid management in septic AKI.