| 脓毒症AKI生物学标志物在CRRT中的临床价值 |
| 投稿时间：2016-12-06 修订日期：2016-12-19 点此下载全文 |
| 引用本文：胡明磊,金献冠,李钰.脓毒症AKI生物学标志物在CRRT中的临床价值[J].医学研究杂志,2017,46(9):100-103,191 |
| DOI：
10.11969/j.issn.1673-548X.2017.09.027 |
| 摘要点击次数: 1184 |
| 全文下载次数: 685 |
|
| 基金项目:浙江省温州市科技计划项目（Y20140262） |
|
| 中文摘要:目的 探讨胱抑素C （cystatin C，Cys C）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin，NGAL）、尿白细胞介素18（interleukin-18，IL-l8）在脓毒症急性肾损伤（acute kidney injury，AKI）患者早期预测选择连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）及治疗置换模式不同比较中的临床价值评估。方法 选择2012年7月~2016年4月收治的脓毒症且并发AKI的患者，确诊后24h内收集患者血清Cys C、尿NGAL和尿液IL-18标本，用ELISA法分别检测血清Cys C、尿NGAL和尿液IL-18标本水平，同时收集血肌酐（Scr）、尿素氮（BUN）、血白细胞等临床指标。根据患者在之后住院期间是否需要接受CRRT，分为脓毒症CRRT组和脓毒症非CRRT组，对两组进行对比分析，同时脓毒症CRRT组治疗前后在动脉端采取血液标本及尿液标本检测；通过ROC曲线下面积评价血清Cys C、尿NGAL和尿液IL-18浓度在评价脓毒症AKI患者需CRRT的早期预测价值，对CRRT治疗中患者进行单纯随机抽样分组分为2L/h及4L/h置换剂量组，同时和不同时间点的血清Cys C、尿NGAL和尿液IL-18浓度进行单因素方差分析。结果 总共收集71例脓毒症AKI患者，男性占63.3%，患者年龄21~86岁，平均年龄63.9±14.8岁。36例患者最后接受CRRT治疗，确诊AKI后的24h内，2组患者Scr、BUN、血白细胞等临床指标比较，差异无统计学意义（P>0.05）；但脓毒症CRRT组尿血清Cys C、尿NGAL和尿液IL-18浓度水平明显高于脓毒症非CRRT组（P<0.05）。血清Cys C、尿NGAL和尿液IL-18浓度在预测脓毒症AKI患者需CRRT治疗的ROC曲线下面积分别是血清Cys C对于脓毒血症AKI患者需进行CRRT治疗的预测价值的AUC值为0.905（95% CI：0.831~0.979，P=0.000），尿NGAL、尿IL-18预测价值的AUC值分别为0.926（95% CI：0.862~0.991，P=0.000）和0.897（95% CI：0.827~0.967，P=0.000）。在CRRT治疗过程中，置换液流量为分别设定2L/h及4L/h置换剂量行分组透析治疗，2L/h组透析患者数为17例，4L/h组透析患者数为19例。经过12、24h治疗后，血清Cys C、尿NGAL和尿液IL-18在各组内逐渐下降（P<0.05），4L/h组血清Cys C、尿NGAL和尿液IL-18在第24h均明显低于2L/h组（P<0.05）。结论 血清Cys C、尿NGAL和尿液IL-18在脓毒症AKI患者选择CRRT治疗时机中有一定的参考价值，其中尿NGAL具有更好的早期预测价值，其次为血清Cys C和尿IL-18。此外，在CRRT治疗过程中，置换液流量为4L/h透析治疗比2L/h组透析患者在持续24h治疗后，可能有更好的治疗效果。 |
| 中文关键词:胱抑素C 中性粒细胞明胶酶相关脂质运载蛋白 白细胞介素18 急性肾损伤 连续性肾脏替代治疗 |
| |
| A Prospective Study on the Evaluation Method about the Biomarkers of Systemic Inflammatory Response Syndrome(Sepsis)Complicated with Acute Kidney Injury(AKI) During Continuous Renal Replacement Therapy(CRRT) |
|
|
| Abstract:Objective To evaluate the predictive value of serum cystatin C(sCys C), urinary neutrophil gelatinase associated lipocalin(uNGAL) and interleukin-18(uIL-18)in early diagnosis of continuous renal replacement therapy (CRRT) in systemic inflammatory response syndrome(Sepsis)complicated with acute kidney injury(AKI) and difference post-replacement volume in CRRT. Methods Total of 71 patients admitted to the intensive care unit during from July 2012 to April 2016 were included in the current prospective study.The patients were assigned into the CRRT and non-CRRT groups based on whether the patients were accepted the CRRT.sCys C, uNGAL,uIL-18,serum creatine,blood urea nitrogen and leukocyte were measured on the day of admission.We collected blood and urinary samples at different time points (12h,24h)in order to measure sCys C, uNGAL,uIL-18 when the patients accepted difference post-replacement volume(2L/h and 4L/h) in CRRT. Multivariate logistic regression analysis was used to determine whether sCysC,uNGAL and uIL-18 levels were independent predictors of Sepsis complicated with AKI.A receiver operating characteristic(ROC) curve was constructed and the area under the ROC curve(AUC)was calculated to assess the predictive strength of sCys C,uNGAL and uIL-18. Results Compared to the Non-CRRT subjects,the age,the gender,Scr,BUN,WBC in the subjects of the CRRT group were of no significant diffience,but the levels of sCys C,uNGAL and uIL-18 were significantly higher(P<0.05).sCys C,uNGAL and uIL-18 achieved the AUC of 0.905(95%CI:0.831-0.979, P=0.000),0.926(95%CI:0.862-0.991, P=0.000),0.897(95%CI:0.827-0.967, P=0.000),respectively,for predicting the development of Sepsis complicated with AKI.No significant differences were noted between 2L/h group with 4L/h group at the beginning of CRRT.The levels of sCys C,uNGAL and uIL-18 decreased significantly in 2L/h and 4L/h groups at different time points (12h,24h) during CRRT. The levels of sCys C,uNGAL and uIL-18 in 4L/h group had decreased more significantly than 2L/h group at the 24h time point. Conclusion The authors consider that sCys C,uNGAL and uIL-18 are both independent predictors of Sepsis complicated with AKI in CRRT.uNGAL has a better predictive value in early prediction of Sepsis complicated with AKI in CRRT.There was more significant treatment effect in the post-replacement volume of 4L/h after 24h treatment in CRRT. |
| keywords:Cystatin C Neutrophil gelatinase associated lipocalin Interleukin-18 Acute kidney injury Continuous renal replacement therapy |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
