体外循环免疫净化技术多靶点救治妊娠并发急性肾衰竭的研究  

A Clinical Study of Multitarget Remedy Pregnancy Complicating Acute Renal Failure by Extracorporeal Circulation Immune Purification

作　　者：孟建中[1] 吕苏一[1] 周春华[2] 何萍[2] 刘文渊[1] 王素霞[1] 葛彦明[1] 贾凤玉[1] 岳冀[1] 

机构地区：[1]中国人民解放军济南军区总医院,济南250031 [2]中国人民解放军海军总医院,北京100023

出　　处：《生物医学工程研究》2011年第4期239-243,共5页Journal Of Biomedical Engineering Research

摘　　要：探讨"AKIN"标准及病理诊断指导下实施体外循环免疫净化(ECIP)救治妊娠期并发急性肾衰竭(ARF)对预后的影响。(1)观察ECIP干预时机对肾功能延迟恢复发生率、病死率的影响。根据"AKIN"标准分为两组:A组14例(37.84%)在AKI损伤期实施ECIP;B组23例(62.16%)在AKI衰竭期实施ECIP。(2)观察ECIP治疗前后,急性生理功能和慢性健康状况评分系统II(APACHEII)评分值、血肌酐(Scr)、尿酸(UA)、半胱氨酸蛋白酶抑制蛋白C(CysC)、乳酸脱氢酶(LDH)等动态变化。对7例肾功能延迟患者实施经皮肾穿刺活检术,观察其病理类型变化。结果表明:(1)产后患者出现少尿,血CysC、UA水平和APACHEII评分值明显增高,在48 h达高峰;而Scr浓度于产后48 h增高,在产后72 h达高峰;经ECIP治疗后,患者血CysC、UA、Scr、LDH水平和APACHEⅡ值明显降低。经相关分析发现,患者血UA水平与血清CysC含量变化呈现正相关(r=0.61,P<0.05)。(2)肾功能恢复率(Scr回到基线水平):A组明显高于B组(P<0.05)。(3)33例(89.19%)肾功能得以恢复。B组患者死亡2例(5.41%),死亡原因为严重感染、多脏器功能不全;肾脏死亡2例,需依赖透析维持生命(5.41%)。(4)肾功能延迟恢复者的肾脏病理主要类型为:溶血性尿毒综合征、新月体肾炎、毛细血管内增生性肾炎及血管炎。妊娠AKI是一种特殊类型的系统性疾病,肾小球固有细胞的损伤是导致此类患者人/肾死亡的重要原因。半胱氨酸蛋白酶抑制蛋白C(CysC)能敏感、精确地反映肾小球滤过率变化(GFR)。根据AKIN分层诊断标准,选择"适宜"的ECIP时机调整免疫功能,能保护肾固有细胞,改善预后。To investigate the influence of extracorporeal circulation immune purification(ECIP) which remedy pregnancy complicating acute renal failure(ARF) under the guidance of acute kidney injury hierarchical diagnosis normality(AKIN) and pathologic diagnosis on prognosis.(1)To observe the influence which interference occasion on the incidence of renal function delayed recovery and fatality rate.According to AKIN,thirty-seven patients were divided into following groups,14 patients(37.84%) executed ECIP during the stage of damage in AKI as group A,23 patients(62.16%) treated in the same way at the stage of exhaustion in AKI as group B.(2)To observe the dynamic state changes(ECIP pretherapy and post-treatment) of acute physiology and chronic health evaluation II(APACHEII) score,the levels of serum creatinine(Scr),uric acid(UA),cystatin C(CysC),lactate dehydrogenase(LDH) were observed.7 patients which renal function delayed recovery executed percataneous renal needle biopsy and got their pathologic changes analyzed.The result showed that(1) Oliguria happened in postpartum patients,their blood CysC,UA levels and APACHEII score also increased significantly,peaked at 48 h.Scr levels increased at postpartum 48 h and peaked at 72 h.Levels of blood CysC,UA,Scr,LDH and the APACHEⅡ score decreased obviously after ECIP.Correlation analysis showed that the content of blood UA were positively related to CysC(r=0.61,P<0.05).(2)The renal functional rehabilitation rate(Scr back to the baseline) of group A were obviously higher than that of group B(P<0.05).(3)Renal function of 33 patients(89.19%) got recovered.2 patients(5.41%) in group B were died of severe infection and multiorgan functional defection.2 patients with dead kidney(5.41%) depended on dialysis to maintain life.(4)The major histologic types of the patients whose renal function recovery delayed were uremic syndrome hemolytic,crescentic glomerulonephritis,endocapillary proliferative glomerulonephritis and vasculitis.As a special kind of systemic disease,the injury of kidney

关 键 词：体外循环免疫净化 妊娠 急性肾损伤 AKIN分期 半胱氨酸蛋白酶抑制蛋白C 

分 类 号：R318[医药卫生—生物医学工程]