脓毒症合并急性肾损伤患者行持续性肾脏替代治疗时机的探讨  

Exploration of treatment timing for continuous renal replacement therapy in patients with sepsis complicated with acute kidney injury

作　　者：赵璟[1] 史晶心 冯丽霞[1] ZHAO Jing;SHI Jing-xin;FENG Li-xia(Department of Critical Care Medicine,Nanyang First People's Hospital,Nanyang 473000,China)

机构地区：[1]河南省南阳市第一人民医院重症医学科,河南南阳473000

出　　处：《实用医院临床杂志》2024年第3期55-59,共5页Practical Journal of Clinical Medicine

基　　金：南阳市科技攻关计划项目(编号:KJGG098)。

摘　　要：目的探讨脓毒症合并急性肾损伤(AKI)患者行持续性肾脏替代治疗(CRRT)的最佳治疗时机。方法我院收治的86例脓毒症合并AKI患者,其中44例行早期CRRT治疗(早期组),42例行标准CRRT治疗(标准组),记录两组预后转归情况及入院时、入院24、48及72 h肾损伤标志物[肾损伤分子-1(KIM-1)、中性粒细胞明胶酶脂质运载蛋白(NGAL)、肝型脂肪酸结合蛋白(L-FABP)]变化情况;根据标准组入院28 d生存情况分为生存组及死亡组,比较两组CRRT治疗时机、入院24 h肾损伤标志物差异,分析入院24 h肾损伤标志物对标准CRRT治疗预后死亡的预测价值。结果早期组与标准组入院28 d死亡率比较,差异无统计学意义(P>0.05);早期组入院至行CRRT时间、CRRT持续时间、ICU住院时间及依赖透析率均低于标准组,脱离透析率高于标准组(P<0.05)。从入院时至入院72 h,早期组血清KIM-1、NGAL、L-FABP水平先升高后下降,标准组则升高后稳定(P<0.05);入院48、72 h时早期组血清KIM-1、NGAL、L-FABP水平均低于标准组(P<0.05)。行标准CRRT治疗患者中,死亡组入院至行CRRT时间及入院24 h血清KIM-1、NGAL、L-FABP水平均显著高于生存组(P<0.05);经ROC曲线分析发现入院24 h血清KIM-1、NGAL、L-FABP水平均对标准CRRT治疗预后死亡有较高预测价值(P<0.05),其截断值分别为2.98 ng/L、23.53 ng/L、20.02μg/ml,且3项联合预测价值最高。结论早期CRRT治疗能使脓毒症合并AKI患者尽早脱离透析,入院24 h血清KIM-1、NGAL、L-FABP水平对预测标准CRRT治疗预后不良有利,有望成为指导CRRT治疗的新指标。Objective To explore the best treatment timing of continuous renal replacement therapy(CRRT)in patients with sepsis complicated with acute kidney injury(AKI).Methods Eighty-six patients with sepsis complicated with AKI in our hospital were selected.Among the patients,44 received early CRRT treatment(early group)and 42 cases were given standard CRRT treatment(standard group).The prognosis and outcomes and kidney injury markers such as kidney injury molecule-1(KIM-1),neutrophil gelatinase lipocalin(NGAL)and liver-type fatty acid binding protein(L-FABP)at admission,after 24,48 and 72 hours of admission were recorded in the two groups.According to the survival status after 28 days of admission,the patients in the standard group were further divided into a survival group and a death group.The differences in CRRT treatment timing and kidney injury markers after 24 hours of admission were compared between the two groups.The predictive value of kidney injury markers after 24 h of admission on prognosis of death after standard CRRT treatment was analyzed.Results There was no significant difference between the early group and the standard group in terms of mortality rate after 28 days of admission(P>0.05).However,the time from admission to CRRT,CRRT duration,ICU stay and dependent dialysis rate in the early group were shorter than those in the standard group(P<0.05)while the renal recovery rate was higher than that in the standard group(P<0.05).During the period from admission to 72 hours of admission,the levels of serum KIM-1,NGAL and L-FABP in the early group were increased first and then decreased(P<0.05),and the levels in the standard group showed a stable trend after increasing(P<0.05).After 24,48 and 72 hours of admission,the levels of serum KIM-1,NGAL and L-FABP were lower in the early group than those in the standard group(P<0.05).Among the patients with standard CRRT treatment,the time from admission to CRRT and the levels of serum KIM-1,NGAL and L-FABP after 24 hours of admission in the death group were significa

关 键 词：脓毒症 急性肾损伤 持续性肾脏替代治疗 时机 肾损伤标志物 

分 类 号：R459.5[医药卫生—治疗学]