脓毒症AKI患者NGAL、KIM 1、Cys C在CRRT联合活血解毒益气汤治疗后的表达及其预后价值

目的:观察连续性肾脏替代疗法(CRRT)联合活血解毒益气汤对脓毒症急性肾损伤(AKI)患者中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子1(KIM 1)、胱抑素C(Cys C)的影响,探讨这些指标预测患者预后的价值。方法:选取脓毒症患者120例作为研究对象,其中发生AKI者62例,设为AKI组,未发生AKI者58例,设为非AKI组。AKI组采取CRRT联合活血解毒益气汤治疗,非AKI组采取常规基础治疗。观察两组治疗后急性生理与慢性健康评价Ⅱ(APACHEⅡ)分数、序贯器官衰竭评价(SOFA)分数、脑钠肽(BNP)、氧合指数、ICU滞留时间、平均住院天数等常规指标;观察两组患者进入ICU后0 h、6 h、12 h、24 h、48 h血清肌酐(SCr)、NGAL、KIM 1、Cys C的变化情况;分析两组治疗前后Cys C、NGAL、KIM 1水平与SCr水平、SOFA分数、APACHEⅡ分数的相关性;随访28 d,记录两组预后情况,并分析NGAL、KIM 1、Cys C对患者肾脏功能转归和病死率的预测价值。结果:治疗后两组APACHEⅡ分数、SOFA分数、BNP、氧合指数、ICU滞留时间、平均住院天数比较差异有统计学意义(P0.05)。AKI组SCr、Cys C在入室12 h升高最显著,KIM 1在入院24 h后升高最显著,NGAL在入室0 h时水平最高,均达到峰值,治疗结束后所有指标水平均下降,与非AKI组治疗结束后比较,差异有统计学意义(P0.05)。NGAL水平、Cys C水平与APACHEⅡ分数呈正相关性。AKI组治疗后近期死亡18例(29.03%),死亡原因大部分为脏器功能衰竭、严重感染或呼吸衰竭;存活44例,其中肾功能慢慢恢复并脱离透析者21例(47.73%),肾脏丢失者23例(52.27%)。结论:CRRT联合活血解毒益气汤治疗通过降低脓毒症AKI患者Cys C水平,调节KIM 1、NGAL表达保护肾功能;NGAL、KIM 1、Cys C可作为预测患者预后的独立指标,NGAL、Cys C的预测价值较高,KIM 1的预测价值较低。

Expressions of NGAL,KIM 1 and Cys C in Patients with Sepsis-Induced Acute Kidney Injury Treated by CRRT Combined with Huoxue Jiedu Yiqi Decoction and Their Prognostic Value

Objective:To observe the expressions of neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule 1(KIM 1) and cystatin C(Cys C) in patients with sepsis-induced acute kidney injury(AKI) treated by continuous renal replacement therapy(CRRT) combined with Huoxue Jiedu Yiqi Decoction and analyze their prognostic value. Methods:A total of 120 patients with sepsis were divided into AKI group(62 cases with sepsis-induced AKI) and non-AKI group(58 cases without sepsis-induced AKI).The AKI group was treated with CRRT combined with Huoxue Jiedu Yiqi Decoction and the non-AKI group was treated with conventional basic therapy. After treatment,routine parameters of the two groups such as acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score,sequential organ failure assessment(SOFA) score,brain natriuretic peptide(BNP),oxygenation index,ICU retention time,average length of hospital stay and so on were observed. The levels of serum creatinine(SCr),NGAL,KIM 1 and Cys C of the two groups were observed at the 0 th,6 th,12 th,24 th and 48 th hour in ICU. The correlation between levels of Cys C,NGAL,KIM 1 and SCr level,SOFA score,APACHE Ⅱ score of the two groups was analyzed before and after treatment. After treatment,the patients were followed for 28 days to record the prognosis.At the same time,the value of NGAL,KIM 1 and Cys C in predicting kidney function and death rate of the patients were analyzed. Results:After treatment,the differences of APACHE Ⅱ scores,SOFA scores,BNP,oxygenation index,ICU retention time and average length of hospital stay between the two groups were statistically significant(P<0.05). In the AKI group,the levels of SCr,Cys C reached a peak value at the12 th hour in ICU,the level of KIM 1 reached a peak value at the 24 th hour in ICU and the level of NGAL reached a peak value at the 0 th hour in ICU. After treatment,all the above parameters of the AKI group were decreased and the differences of these parameters between the two groups were statistically significant(P<0.05). The NGAL level,Cys C level and APACIIE Ⅱ scores were positively correlated. In the AKI group,18 patients(29.03%) died shortly after the treatment. The major causes of death were organ failure,severe infection or respiratory failure. Among the survived 44 cases,21 cases(47.73%) had renal function recovery and were out of dialysis,but the other 23 cases(52.27%) had kidney loss. Conclusions:CRRT therapy combined with Huoxue Jiedu Yiqi Decoction can protect the renal function of patients with sepsis-induced AKI by reducing the level of Cys C and regulating the expressions of KIM 1 and NGAL.The levels of NGAL,KIM 1 and Cys C can be used as independent prognostic parameters for the patients.The predictive value of NGAL and Cys C is high,but the predictive value of KIM 1 is low.