肝硬化患者急性肾损伤的分期与临床疗效的关系

目的 探讨肝硬化初发急性肾损伤(acute kidney injury,AKI)患者的AKI分期与补液扩容为主的综合治疗的疗效关系,探讨AKI分期与尿肾损伤分子-1(kidney injury molecule-1,KIM-1)水平的关系.方法 2014年9月至2017年1月收治肝硬化合并新发AKI患者61例,分为AKI 1期及2～3期,停用利尿剂、血管扩张剂及肾毒性药物,给予补液扩容为主的综合治疗48 h,评价初发AKI时、治疗48 h两个时间点的疗效;采用ELISA方法检测尿KIM-1,分析AKI分期与疗效、尿KIM-1的关系.结果 61例肝硬化初发AKI患者,AKI 1期47例,2～3期14例;治疗48 h后,AKI 1期治疗有效率高于AKI 2～3期(63.8％ vs.28.6％,P＜0.05);相同AKI分期患者治疗48 h前后血BUN、SCr和尿KIM-1的差异均有统计学意义(P＜0.05).AKI 1期患者对扩容治疗的疗效优于2～3期.AKI 1期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.310,P=0.766);AKI 2～3期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.392,P=0.696).结论 肝硬化初发AKI患者的分期越高,尿KIM-1水平越高;扩容治疗无效组尿KIM-1水平高于有效组.

Relationship between the stage of cirrhosis complicated with newly developed acute kidney injury and the efficacy of clinical treatment

Objective To investigate the relationships between the stage of cirrhosis complicated with newly developed acute kidney injury (AKI) and the effects of circulatory volume expansion therapy,the level of urinary kidney injury molecule-1 (KIM-1) measured before or after the expansion therapy.Methods Recruited from September,2009 to January,2017,a total of 61 patients with cirrhosis complicated with newly developed AKI were categorized as stage I or stage Ⅱ/Ⅲ.Diuretics,vasodilators and medications with nephrotoxicity were discontinued and circulatory volume expansion therapy and intravenous infusion of albumin were applied.Forty-eight hours later,the efficacy of the treatment was analyzed.KIM-1 were examined in urine samples.The relationship of AKI stages with both treatment effects and the level of urinary KIM-1 were analyzed.Results A total of 61 patients with cirrhosis complicated with newly developed AKI consisted of 47 at stage Ⅰ and 14 at stage Ⅱ/Ⅲ.Forty-eight hours after expansion therapy,effective rate was higher in patients of stage Ⅰ than that of stage Ⅱ/Ⅲ (63.8％ vs.28.6％,P ＜ 0.05).There was significant difference in BUN,SCr,KIM1 before and after the treatment in the same stage of AKI (P ＜ 0.05).The efficacy was better in AKI stage Ⅰ than stage Ⅱ / Ⅲ.The levels of urine KIM-1 in patients at stage Ⅰ and Ⅱ / Ⅲ showed no difference before and after expansion treatment (P ＞ 0.05).Conclusion The higher level of KIM-1 in urine,the more advance the AKI stage.The level of KIM-1 is higher in treatment ineffective group than in the treatment effective group.