脓毒症早期患者血清心钠肽和尿肾损伤分子-1水平变化及其临床意义  

Changes and Clinical Significance of Serum Atrial Natriuretic Peptide and Urinary Kidney Injury Molecule-1 in Patients with Early Sepsis

作　　者：何永来[1] 徐慧玲[2] 李建华[1] 田培刚[1] 程青虹[1] 

机构地区：[1]新疆石河子大学医学院第一附属医院ICU,新疆石河子市832002 [2]石河子大学医学院

出　　处：《中国全科医学》2014年第17期2030-2032,共3页Chinese General Practice

摘　　要：目的探讨脓毒症早期患者血清心钠肽(ANP)和尿肾损伤分子-1(KIM-1)水平变化及其临床意义。方法选择2012年1—3月新疆石河子大学医学院第一附属医院ICU收治的脓毒症患者共9例,采用酶联免疫吸附法检测其发病2、6、12、24、48 h时和3、4、5、6、7 d时血清ANP、血肌酐及尿KIM-1水平,同时记录急性生理与慢性状况评分系统Ⅱ评分(APACHEⅡ评分)。结果本组患者不同时间点血肌酐、APACHEⅡ评分比较,差异无统计学意义(P>0.05);不同时间点血清ANP、尿KIM-1水平比较,差异有统计学意义(P<0.05),其中血清ANP水平在6、12、24、48 h时高于2 h时(P<0.05),尿KIM-1水平在2 h时低于6 h时,12、24 h时高于6 h时(P<0.05)。Pearson相关分析显示,脓毒症患者血清ANP、尿KIM-1水平均与血肌酐水平呈正相关(r=0.925,P=0.000;r=0.880,P=0.002),亦均与APACHEⅡ评分呈正相关(r=0.715,P=0.031;r=0.798,P=0.010);血清ANP水平与尿KIM-1水平呈正相关(r=0.892,P=0.001)。结论脓毒症早期患者血清ANP水平和尿KIM-1水平变化可以更早地反映肾损害的发生及疾病严重程度,动态监测血清ANP水平和尿KIM-1水平,并结合血肌酐水平和APACHEⅡ评分对于判断患者预后具有重要意义。Objective To investigate the changes of serum atrial natriuretic peptide（ANP） and urinary kidney injury molecule-1（KIM-1） in early septic patients.Methods From January to March 2012,serum ANP,serum creatinine（Scr）,urinary KIM-1 levels were determined,by enzyme linked immunosorbent assay,in 9 septic patients admitted to ICU of the First Affiliated Hospital of Medical College,Shihezi University,at hours 2,6,12,24,48,on days 3,4,5,6,7 after onsets.The acute physiology and chronic health evaluationⅡ（APACHEⅡ） scores were recorded.Results There was no significant difference in Scr,APACHEⅡ scores between differenct time points（P〉0.05）,there was in serum ANP,urinary KIM-1 levels（P〈0.05）;ANP level was higher at hours 6,12,24,48 than at hour 2（P〈0.05）,and KIM-1 level lower at hour 2 than at hour 6,higher at hours 12,24 than at hour 6（P〈0.05）.By Pearson correlation analysis,serum ANP,urinary KIM-1 levels were positively correlated with Scr level（r=0.925,P=0.000;r=0.880,P=0.002）,positively with APACHEⅡ scores（r=0.715,P=0.031;r=0.798,P=0.010）;serum ANP positively with urinary KIM-1（r= 0.892,P=0.001）.Conclusion The changes of serum ANP,urinary KIM-1 levels can reflect earlier the occurrence of renal damage and severity of disease.Dynamic monitoring of ANP and KIM levels combined with Scr level and APACHEⅡ scores is of importance in judging patients＇ prognosis.

关 键 词：脓毒症 全身炎症反应综合征 心钠肽 肾损伤分子-1 

分 类 号：R631[医药卫生—外科学]