Etiology and management of liver injury in patients with COVID-19

The outbreak of novel coronavirus disease 2019(COVID-19)has resulted in global emergence.With the expansion of related research,in addition to respiratory symptoms,digestive system involvement such as nausea,vomiting,and diarrhea have also been reported with COVID-19.Besides,abnormal liver function is also frequent in biochemical tests of COVID-19 patients,which is correlated with the severity and mortality of the disease course.The etiology of liver injury in patients with COVID-19 might include viral immunologic injury,drug-induced liver injury,the systemic inflammatory response,hypoxic hepatitis,and the exacerbation of preexisting liver disease.Although liver injuries in COVID-19 are often transient and reversible,health workers need to pay attention to preexisting liver disease,monitor liver function,strengthen supportive treatment,and reduce the chance of drug-induced liver injury.This article reviews the epidemiological characteristics,etiology,management,and preventive strategies for liver injury in patients with COVID-19.

Ligliptin for treatment of type 2 diabetes mellitus with early renal injury: Efficacy and impact on endogenous hydrogen sulfide and endothelial function

BACKGROUND Diabetes is a clinically common chronic disease,and its incidence has been increasing in recent years.Diabetes is believed to accelerate the process of atherosclerosis in patients,and abnormal endothelial function is an important factor leading to diabetic kidney damage.AIM To investigate the efficacy of ligliptin in the treatment of type 2 diabetes mellitus(T2DM)with early renal injury and its effect on serum endogenous hydrogen sulfide(H2S),endothelial cell particles,and endothelial function.METHODS From January 2018 to April 2019,110 patients with T2DM and early kidney injury treated at our hospital were divided into an observation group(receiving ligliptin treatment,n=54)and a control group(receiving gliquidone therapy,n=56).Blood glucose and renal function before and after treatment were compared between the two groups.RESULTS The differences in fasting blood glucose,2 h blood glucose,and glycated hemoglobin were not statistically significant between the two groups after treatment.The urinary albumin excretion rate after treatment in the ligliptin group was 70.32±11.21μg/min,which was significantly lower than that of the gliquidone group(P=0.000).Serum endogenous H2S and endothelial cell microparticles of the ligliptin treatment group were 40.04±8.82 mol/L and 133.40±34.39,respectively,which were significantly lower than those of the gliquidone treatment group(P=0.000 for both);endothelin-dependent diastolic function and nitric oxide after treatment in the ligliptin group were 7.98%±1.22%and 190.78±30.32 mol/L,significantly higher than those of the gliquidone treatment group(P=0.000 for both).CONCLUSION Ligliptin treatment of T2DM with early renal injury has the same glucoselowering effect as gliquidone treatment.Ligliptin treatment has a better effect and it can significantly improve the renal function and vascular endothelial function of patients,and reduce serum endogenous H2S and endothelial cell particle levels.

Therapeutic potential of urine-derived stem cells in renal regeneration following acute kidney injury:A comparative analysis with mesenchymal stem cells

BACKGROUND Acute kidney injury(AKI)is a common clinical syndrome with high morbidity and mortality rates.The use of pluripotent stem cells holds great promise for the treatment of AKI.Urine-derived stem cells(USCs)are a novel and versatile cell source in cell-based therapy and regenerative medicine that provide advantages of a noninvasive,simple,and low-cost approach and are induced with high multidifferentiation potential.Whether these cells could serve as a potential stem cell source for the treatment of AKI has not been determined.METHODS Stem cell markers with multidifferentiation potential were isolated from human amniotic fluid.AKI severe combined immune deficiency(SCID)mice models were induced by means of an intramuscular injection with glycerol.USCs isolated from human-voided urine were administered via tail veins.The functional changes in the kidney were assessed by the levels of blood urea nitrogen and serum creatinine.The histologic changes were evaluated by hematoxylin and eosin staining and transferase dUTP nick-end labeling staining.Meanwhile,we compared the regenerative potential of USCs with bone marrow-derived mesenchymal stem cells(MSCs).RESULTS Treatment with USCs significantly alleviated histological destruction and functional decline.The renal function was rapidly restored after intravenous injection of 5×105 human USCs into SCID mice with glycerol-induced AKI compared with injection of saline.Results from secretion assays conducted in vitro demonstrated that both stem cell varieties released a wide array of cytokines and growth factors.This suggests that a mixture of various mediators closely interacts with their biochemical functions.Two types of stem cells showed enhanced tubular cell prolif-eration and decreased tubular cell apoptosis,although USC treatment was not more effective than MSC treatment.We found that USC therapy significantly improved renal function and histological damage,inhibited inflammation and apoptosis processes in the kidney,and promoted tubular epithelial proliferation.CONCLUSION Our study demonstrated the potential of USCs for the treatment of AKI,representing a new clinical therapeutic strategy.

Efficacy of Ulinastatin Combined with Continuous Renal Replacement Therapy in the Treatment of Sepsis Acute Kidney Injury and Its Effects on Systemic Inflammation, Immune Function and miRAN Expression

Objective: To research the effectiveness of ulinastatin in combination with continuous renal replacement therapy in treating sepsis acute kidney injury and its effect on systemic inflammation, immune function and miRAN expression. Methods: The 84 patients who were diagnosed with sepsis complicated by acute kidney injury in our hospital between May 2020 and June 2022 were chosen and randomly assigned to the study group (n = 42) and the control group (n = 42). Ulinastatin in combination with continuous renal replacement therapy was administered to the study group, whereas the control group was administered with continuous renal replacement therapy alone. Both groups’ clinical effects were observed. The levels of blood urea nitrogen (BUN), serum creatinine (SCr), tumor necrosis factor-α (TNF-α), high sensitivity Creactive protein (hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), IgG, IgA, IgM, expression levels of miR-233 and miR-10a were compared among both the groups, pre-, and post-treatment. Results: The study group’s overall effectiveness rate was higher that is 95.24%, in comparison to the control group’s 78.57%, and this difference was statistically significant (P α, hs-CRP, VCAM-1, and miR-233 and miR-10a expression levels in both the study and control groups were decreased, however, the study group had reduced levels in comparison to the control group, with statistically significant differences (P P Conclusion: Ulinastatin in combination with continuous renal replacement therapy for treating sepsis acute kidney injury exhibits a positive effect and can significantly improve the systemic inflammation and immune function in patients.

Effect of continuous low effective dialysis combined with hemoperfusion on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury

Objective:To investigate the effects of sustained low-efficiency dialysis (SLED) combined with hemoperfusion (HP) on inflammatory stress, hemodynamic parameters and renal function in septic patients with severe acute kidney injury.Methods: A total of 82 cases of sepsis with severe acute renal injury were divided into control group (n=41) and observation group (n=41) according to the random data table method. Two groups of patients were given conventional support treatment, on this basis, the control group was treated with Continuous renal replacement therapy (CRRT), and the observation group was treated with SLED plus HP. The levels of inflammatory factors, hemorheological parameters and renal function indexes of the two groups were compared before and after treatment.Results: There was no significant difference in the levels of CRP, WBC, PCT, MAP, OI, BUN and Scr between the control group and the observation group before the treatment. Compared with the level before treatment, the levels of CRP, WBC, PCT, BUN and Scr in the two groups were significantly decreased after treatment, while the levels of MAP and OI were significantly increased. Compared with the level of the control group after treatment, the levels of CRP, WBC, PCT, BUN and Scr in the observation group were significantly lower than those in the control group, the levels of MAP and OI were significantly increased, the difference was statistically significant.Conclusion:SLED combined with HP regimen in treatment of sepsis combined with severe acute kidney injury can effectively inhibit the release of inflammatory factors, improve hemodynamics and renal function, and has an important clinical value.

A pulmonary source of infection in patients with sepsis-associated acute kidney injury leads to a worse outcome and poor recovery of kidney function

BACKGROUND:Hospital mortality rates are higher among patients with sepsis-associated acute kidney injury(SA-AKI)than among patients with sepsis.However,the pathogenesis underlying SA-AKI remains unclear.We hypothesized that the source of infection affects development of SA-AKI.We aim to explore the relationship between the anatomical source of infection and outcome in patients with SA-AKI.METHODS:Between January 2013 and January 2018,113 patients with SA-AKI admitted to our Emergency Center were identifi ed and divided into two groups:those with pulmonary infections and those with other sources of infection.For each patient,we collected data from admission until either discharge or death.We also recorded the clinical outcome after 90 days for the discharged patients.RESULTS:The most common source of infection was the lung(52/113 cases,46%),followed by gastrointestinal(GI)(25/113 cases,22.1%)and urinary(22/113,19.5%)sources.Our analysis showed that patients with SA-AKI had a significantly worse outcome(30/52 cases,P<0.001)and poorer kidney recovery(P=0.015)with pulmonary sources of infection than those infected by another source.Data also showed that patients not infected by a pulmonary source more likely experienced shock(28/61 cases,P=0.037).CONCLUSION:This study demonstrated that the source of infection infl uenced the outcome of SA-AKI patients in an independent manner.Lung injury may influence renal function in an asyet undetermined manner as the recovery of kidney function was poorer in SA-AKI patients with a pulmonary source of infection.

Chronic renal dysfunction in cirrhosis:A new frontier in hepatology

Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising prevalence of risk factors,such as diabetes,hypertension and nonalcoholic fatty liver disease,appears to have contributed significantly to the high prevalence of CKD.Moreover,the diagnosis of CKD in cirrhosis is now based on a reduction in the estimated glomerular filtration rate of<60 mL/min over more than 3 mo.This definition has resulted in a better differentiation of CKD from acute kidney injury(AKI),leading to its greater recognition.It has also been noted that a significant proportion of AKI transforms into CKD in patients with decompensated cirrhosis.CKD in cirrhosis can be structural CKD due to kidney injury or functional CKD secondary to circulatory and neurohormonal imbalances.The available literature on combined cirrhosis-CKD is extremely limited,as most attempts to assess renal dysfunction in cirrhosis have so far concentrated on AKI.Due to problems related to glomerular filtration rate estimation in cirrhosis,the absence of reliable biomarkers of CKD and technical difficulties in performing renal biopsy in advanced cirrhosis,CKD in cirrhosis can present many challenges for clinicians.With combined hepatorenal dysfunctions,fluid mobilization becomes problematic,and there may be difficulties with drug tolerance,hemodialysis and decision-making regarding the need for liver vs simultaneous liver and kidney transplantation.This paper offers a thorough overview of the increasingly known CKD in patients with cirrhosis,with clinical consequences and difficulties occurring in the diagnosis and treatment of such patients.

Bioinformatics Analysis of Genes and Pathways of CD11b^(+)/Ly6C^(intermediate)Macrophages after Renal Ischemia-Reperfusion Injury

Renal ischemia-reperfusion injury(IRI)is a major cause of acute kidney injury(AKI),which could induce the poor prognosis.The purpose of this study was to characterize the molecular mechanism of the functional changes of CD11 b^(+)/Ly6 C^(intermediate)macrophages after renal IRI.The gene expression profiles of CD11 b^(+)/Ly6 C^(intermediate)macrophages of the sham surgery mice,and the mice 4 h,24 h and 9 days after renal IRI were downloaded from the Gene Expression Omnibus database.Analysis of m RNA expression profiles was conducted to identify differentially expressed genes(DEGs),biological processes and pathways by the series test of cluster.Protein-protein interaction network was constructed and analysed to discover the key genes.A total of 6738 DEGs were identified and assigned to 20 model profiles.DEGs in profile 13 were one of the predominant expression profiles,which are involved in immune cell chemotaxis and proliferation.Signet analysis showed that Atp5 a1,Atp5 o,Cox4 i,Cdc42,Rac2 and Nhp2 were the key genes involved in oxidation-reduction,apoptosis,migration,M1-M2 differentiation,and proliferation of macrophages.RPS18 may be an appreciate reference gene as it was stable in macrophages.The identified DEGs and their enriched pathways investigate factors that may participate in the functional changes of CD11 b^(+)/Ly6 C^(intermediate)macrophages after renal IRI.Moreover,the vital gene Nhp2 may involve the polarization of macrophages,which may be a new target to affect the process of AKI.

Effect of tanshinone combined with valsartan therapy on the renal injury and endothelial injury in patients with hypertensive nephropathy

Objective:To study the effect of tanshinone combined with valsartan therapy on the renal injury and endothelial injury in patients with hypertensive nephropathy.Methods: A total of 72 patients with hypertensive nephropathy who were treated in our hospital between January 2013 and April 2016 were selected and randomly divided into the control group (n=36) who received conventional treatment + valsartan therapy and the observation group (n=36) who received conventional treatment + tanshinone combined with valsartan therapy, and both therapies lasted for 2 weeks. Before treatment and after 2 weeks of treatment, automatic biochemical analyzer was used to determine the renal function indexes in peripheral blood, enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of endothelial injury markers and inflammatory cytokines in peripheral blood, and RIA method was used to determine the serum levels of oxidative stress indexes.Results:Before treatment, the differences in the peripheral blood renal function indexes and endothelial injury markers as well as the serum inflammatory factors and oxidative stress indexes were not statistically significant between two groups of patients. After 2 weeks of treatment, peripheral blood renal function indexes Scr and BUN levels as well as urine mAlb level of observation group were lower than those of control group, and endothelial injury indexes E-selectin and ET levels were lower than those of control group while NOS and CGRP levels were higher than those of control group;serum inflammatory cytokines IL-1, IL-6, CRP and TNF-α levels of observation group were lower than those of control group, and oxidative stress index GSH-Px level was higher than that of control group while MDA and AOPP levels were lower than those of control group. Conclusion: Tanshinone combined with valsartan can reduce the renal injury and endothelial injury in patients with hypertensive nephropathy, and the specific mechanism may be related to controlling the systemic inflammatory response and oxidative stress reaction.

Diabetes mellitus is a risk factor of acute kidney injury in liver transplantation patients

Background: Diabetes mellitus has become an increasing global health burden with rapid growing prevalence. Patients with diabetes have higher susceptibility to acute kidney injury(AKI). Liver transplantation(LT) predisposes the kidney to injury. However, the association between diabetes and AKI in LT patients remains unclear. Methods: We conducted a retrospective cohort study examining risk factors for AKI in patients undergone orthotopic LT. Potential risk factors including baseline estimated glomerular filtration rate(e GFR), the model for end-stage liver disease(MELD) score, diabetes, hypertension and intraoperative blood loss were screened. The primary endpoint was AKI occurrence. Multivariate logistic regression was used to analyze the association between potential risk factors and AKI. Results: A total of 291 patients undergone orthotopic LT were included in the present study. Among them, 102 patients(35.05%) developed AKI within 5 days after LT. Diabetes was identified as an independent risk factor for AKI. Patients who developed AKI had worse graft function recovery and higher mortality within 14 days after LT compared to those who did not develop AKI. AKI patients with diabetes had a significant decline of e GFR within the first postoperative year, compared with patients who did not develop AKI and who developed AKI but without diabetes. Conclusions: Diabetes is an independent risk factor for AKI after orthotopic LT. AKI is associated with delayed graft function recovery and higher mortality in short-term postoperative period. Diabetic patients who developed AKI after LT experience a faster decline of e GFR within the first year after surgery.

Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery

atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.

Effects of mesencephalic astrocyte-derived neurotrophic factor on sepsis-associated acute kidney injury

BACKGROUND:To determine the protective role of mesencephalic astrocyte-derived neurotrophic factor(MANF) in regulating sepsis-associated acute kidney injury(S-AKI).METHODS:A total of 96 mice were randomly divided into the control group,control+MANF group,S-AKI group,and S-AKI+MANF group.The S-AKI model was established by injecting lipopolysaccharide(LPS) at 10 mg/kg intraperitoneally.MANF(200 μg/kg) was administered to the control+MANF and S-AKI+MANF groups.An equal dose of normal saline was administered daily intraperitoneally in the control and S-AKI groups.Serum and kidney tissue samples were obtained for biochemical analysis.Western blotting was used to detect the protein expression of MANF in the kidney,and enzyme-linked immunosorbent assay(ELISA) was used to determine expression of MANF in the serum,pro-inflammatory cytokines(tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]).Serum creatinine(SCr),and blood urea nitrogen(BUN)were examined using an automatic biochemical analyzer.In addition,the kidney tissue was observed for pathological changes by hematoxylin-eosin staining.The comparison between two groups was performed by unpaired Student’s t-test,and statistics among multiple groups were carried out using Tukey’s post hoc test following one-way analysis of variance(ANOVA).A P-value <0.05 was considered statistically significant.RESULTS:At the early stage of S-AKI,MANF in the kidney tissue was up-regulated,but with the development of the disease,it was down-regulated.Renal function was worsened in the S-AKI group,and TNF-α and IL-6 were elevated.The administration of MANF significantly alleviated the elevated levels of SCr and BUN and inhibited the expression of TNF-α and IL-6 in the kidney.The pathological changes were more extensive in the S-AKI group than in the S-AKI+MANF group.CONCLUSION:MANF treatment may significantly alleviate renal injury,reduce the inflammatory response,and alleviate or reverse kidney tissue damage.MANF may have a protective effect on S-AKI,suggesting a potential treatment for S-AKI.

TyG指数、血压、血糖相关指标与单纯性超重/肥胖患者早期肾功能损伤的关系

目的:探讨TyG指数、血压、血糖相关指标与单纯性超重/肥胖患者早期肾功能损伤(ERFI)的关系及交互作用。方法:选取2017年1月至2021年12月于郑州大学第一附属医院体检的BMI≥24 kg/m 2者3956例为研究对象,按尿白蛋白与肌酐比值(UACR)分组,<3 mg/mmol为对照组(n=3844),3~≤30 mg/mmol为ERFI组(n=112)。采用Logistic回归分析甘油三酯葡萄糖(TyG)指数、血压和糖化血红蛋白(HbA1c)与ERFI的关联,并进一步分析各因素的交互作用。结果:ERFI组的BMI、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、HbA1c、总胆固醇(TG)、TyG指数高于对照组,HDL-C低于对照组(P<0.05)。TyG指数>8.77(OR=2.138,95%CI:1.411~3.240)、正常血压高值(OR=2.450,95%CI:1.652~3.635)和HbA1c 5.61%~<7.00%(OR=1.510,95%CI:1.024~2.226)是单纯性超重/肥胖患者ERFI的危险因素。TyG指数与血压有交互作用(RERI=1.754,95%CI:-0.126~3.636;APAB=0.405,95%CI:0.068~0.741)。结论:TyG指数≥8.77、正常血压高值和HbA1c 5.61%~<7.00%可增加单纯性超重/肥胖患者ERFI的患病风险,且血压与TyG指数存在交互作用。

黄芪煎剂联合还原型谷胱甘肽治疗急性肾损伤的疗效

目的探讨黄芪煎剂联合还原型谷胱甘肽(GSH)治疗急性肾损伤(AKI)的疗效。方法选取2020年3月至2021年12月100例AKI患者,采用随机法分为对照组和观察组,每组各50例。对照组应用GSH治疗,观察组在对照组基础上联合中药黄芪煎剂口服。检测治疗前及治疗7 d、14 d时血清尿酸、肌酐、尿素氮、肾小球滤过率估计值(eGFR)及尿金属蛋白酶组织抑制因子-2(TIMP-2)、胰岛素样生长因子结合蛋白7(IGFBP7)水平,比较两组病情控制时间、住院时间、多尿期时间、少尿期时间、血肌酐恢复时间、不良反应及临床预后。结果治疗7d、14d,两组血清SUA、Scr、BUN、eGFR及尿TIMP-2、IGFBP7水平差异有统计学意义(P<0.05)。两组总有效率、病情控制时间、住院时间、多尿期时间、少尿期时间与Scr恢复时间比较差异有统计学意义(P<0.05)。两组不良反应率及28 d死亡率比较差异无统计学意义(P>0.05)。结论黄芪煎剂联合GSH治疗AKI能够提高临床疗效,降低血清SUA、Scr、BUN水平及尿中TIMP-2、IGFBP7水平,保护肾功能,且不增加不良反应发生率。

肾部分切除术后急性肾损伤及其对手术侧肾脏的远期影响

肾部分切除术是治疗局限性小肾癌的首选方法,但手术过程中通常需要暂时阻断肾动脉,不可避免地引发缺血再灌注损伤,严重者甚至发生急性肾损伤。肾部分切除术后急性肾损伤的诊断常采用急性肾损伤网络标准(AKIN)和风险、损伤、失败、损失、终末期肾脏疾病标准(RIFLE),但使用总肌酐升高水平来评估单侧肾损伤显然不够准确;另外,肾部分切除术中会丢失部分正常肾组织,也导致血肌酐升高。为避免上述因素对诊断造成干扰,笔者首先改良了孤立肾肾部分切除术后急性肾损伤诊断分级方法,提出了诊断肾部分切除术后的急性肾损伤需要考虑到正常肾组织丢失引起的血肌酐升高。接着采用“极端值法”量化了非孤立肾患者手术侧肾脏急性肾损伤的程度。最后还探讨了急性肾损伤对手术侧肾脏的远期影响以及减轻肾部分切除术中缺血再灌注肾损伤的潜在方法。

五藤痛风饮结合隔附子饼灸治疗痛风性肾病疗效及对患者肾功能、血清炎性因子影响探究

目的:评估五藤痛风饮结合隔附子饼灸治疗痛风性肾病疗效及对患者肾功能、血清炎性因子影响。方法:研究纳入64例痛风性肾病患者(2020年5月-2022年6月收治),以随机数表法分为对照组和观察组,各32例。对照组采取常规治疗及非布司他片治疗,观察组在对照组基础上结合五藤痛风饮及隔附子饼灸治疗,观察临床疗效、治疗前后中医证候总积分与肾功能指标、肾功能损伤指标、血清白细胞介素-6(IL-6)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)、不良反应结果:观察组与对照组治疗总有效率比较(96.88%31/32vs78.13%,25/32),P<0.05;治疗前,两组中医证候总积分、肌酐(Scr)、尿素氮(BUN)、尿酸(BUA)等肾功能指标、24h尿蛋白、膀胱素C(Cys-C)及尿β_(2)-微球蛋白(β_(2)-MG)、中性粒细胞明胶酶脂质运载蛋白(NGAL)等肾功能损伤指标、IL-6、PCT、CRPhs-CRP、TNF-α水平比较,P>0.05,治疗后各组中医证候总积分、Scr、BUN、BUA、24h尿蛋白、Cys-C、β_(2)-MG、NGAL、IL-6、PCT、hs-CRP、TNF-α等指标均改善,观察组治疗后中医证候总积分、Scr、BUN、BUA、24h尿蛋白、Cys-C、β_(2)-MG、NGAL、IL-6、PCT、hs-CRP、TNF-α等指标均优于对照组,P<0.05;两组不良反应均较少,P>0.05。结论:五藤痛风饮结合隔附子饼灸治疗痛风性肾病疗效较好,肾功能恢复较好,不良反应少,值得应用。

血清miR-146a、Lp-PLA2与脓毒症急性肾损伤患者肾功能的相关性分析

目的探讨血清微小RNA-146a(miR-146a)、脂蛋白相关性磷脂酶A2(Lp-PLA2)与脓毒症急性肾损伤(AKI)患者肾功能的相关性。方法选取2020年2月—2022年2月本院感染性疾病科住院的88例脓毒症患者进行回顾性分析,根据入院24 h内是否发生AKI分组(包括入院时已发生AKI的患者),将40例发生AKI的患者设为观察组1,48例未发生AKI的患者设为观察组2,另选取同期本院体检中心的45例健康体检者设为对照组。检测、比较3组入院24 h内/体检时血清miR-146a、Lp-PLA2、肾功能[胱抑素C(Cys-C),血肌酐(Scr)]指标。根据脓毒症AKI疾病严重程度,将观察组1患者分为休克组(7例)、重度组(20例)、轻度组(13例),比较脓毒症AKI患者中不同疾病严重程度、不同AKI分期组血清miR-146a、Lp-PLA2、肾功能指标,Pearson分析miR-146a、Lp-PLA2与肾功能指标的相关性,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析miR-146a、Lp-PLA2、肾功能对脓毒症发生AKI的预测效能。结果观察组1入院24 h内血清miR-146a、Lp-PLA2、Cys-C、Scr均高于观察组2及对照组(P<0.05)。脓毒症休克组血清miR-146a、Lp-PLA2、Cys-C、Scr均高于重度组及轻度组(P<0.05)。AKIⅢ期组血清miR-146a、Lp-PLA2、Cys-C、Scr均高于Ⅱ期组及Ⅰ期组(P<0.05)。入院24 h内血清miR-146a、Lp-PLA2与Cys-C、Scr均呈正相关性(P<0.05)(r=0.421、0.417、0.398、0.387)。血清miR-146a、Lp-PLA2、Cys-C、Scr联合检测预测脓毒症发生AKI的AUC为0.798,(95%CI:0.716~0.947),灵敏度是93.13%,特异度是91.84%,联合检测预测脓毒症发生AKI的灵敏度及特异度均高于单独检测(P<0.05)。结论脓毒症AKI患者血清miR-146a、Lp-PLA2呈高表达,与Cys-C、Scr呈相关性,血清miR-146a、Lp-PLA2联合Cys-C、Scr检测可提高对AKI的预测灵敏度及特异度,在脓毒症患者AKI诊断中具有一定的参考价值。

万古霉素相关急性肾损伤及肾功能未恢复危险因素分析

目的探讨患者发生万古霉素相关急性肾损伤(VA-AKI)及VA-AKI患者肾功能未恢复的危险因素。方法选择医院2017年1月至2022年12月收治的使用万古霉素患者的临床资料,统计VA-AKI发生率及治疗药物监测(TDM)情况。分别采用单因素分析及多因素Logistic回归分析评估患者发生VA-AKI及肾功能未恢复的危险因素。结果共纳入158例患者,43例发生VA-AKI(27.22%);有145例患者需进行TDM,其中61例(42.07%)实际进行。多因素Logistic回归分析显示,合并心脏病[OR=0.036,95%CI(0.004,0.308),P=0.002],合并肿瘤[OR=0.103,95%CI(0.012,0.910),P=0.041],行外科手术[OR=0.060,95%CI(0.011,0.324),P=0.001]及联用袢利尿剂[OR=0.090,95%CI(0.022,0.378),P=0.001]是患者发生VA-AKI的独立危险因素;VA-AKI 3期[OR=24.788,95%CI(2.567,239.343),P=0.006]是VA-AKI患者肾功能未恢复的独立危险因素。结论合并心脏病、合并肿瘤、行外科手术、联用袢利尿剂是患者发生VA-AKI的独立危险因素;VA-AKI 3期是患者肾功能未恢复的独立危险因素。

儿童先天性SFK的研究进展

儿童先天性SFK(congenital solitary functioning kidney,cSFK)是慢性肾脏病的主要原因之一。肾脏长期高滤过导致肾损害发生,表现为高血压、蛋白尿、肾小球滤过率下降等。由于cSFK患儿早期临床表现并不显著,且更易发生肾损害从而进展至终末期肾病,因此应对其进行长期管理,积极干预,改善远期预后。现就cSFK的发病机制、肾功能受损的病理生理基础、临床表现及长期管理等方面进行综述。

特利加压素联合去甲肾上腺素对ICU脓毒性休克患者D-乳酸及心肌损伤指标的影响

目的:探究特利加压素联合去甲肾上腺素对重症监护室(ICU)脓毒性休克患者D-乳酸及心肌损伤指标的影响。方法:回顾性选取2019年1月—2023年12月苏州大学附属第一医院收治的116例脓毒性休克患者,按治疗方法不同分为两组,各58例。两组均予以常规治疗,对照组予以去甲肾上腺素治疗,观察组在对照组基础上联合特利加压素治疗。比较两组D-乳酸、心肌损伤指标、肾功能、不良反应。结果:两组治疗前D-乳酸、心肌损伤指标、肾功能指标对比,差异均无统计学意义(P>0.05);观察组治疗36 h后D-乳酸、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)、胱抑素C(CysC)、血肌酐(Scr)、血尿素氮(BUN)均较对照组低,差异均有统计学意义(P<0.05);两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论:特利加压素联合去甲肾上腺素治疗ICU脓毒性休克患者可有效降低D-乳酸水平,改善肾功能,减轻心肌损伤,且安全可靠。