摘要
目的观察连续性肾脏替代治疗(continuous renal replacement herapy,CRRT)对严重脓毒症急性肾损伤(acute kidney injury,AKI)患者肝型脂肪酸结合蛋白表达水平的影响。方法确诊严重脓毒症AKI患者68例,分为常规药物治疗组(A组,n=33例)和CRRT组(B组,n=35例)。2组均在确诊严重脓毒症后,立即给予规范的抗脓毒症治疗(按照2012年SCC标准),B组在规范治疗的基础上同步行CRRT 24h。2组均监测0h、12h、24h及48h血肌酐(serum creatinine,s Cr)、血L-FABP(serum L-FABP,s L-FABP)、尿L-FABP(urine L-FABP,u L-FABP)水平,同时监测B组CRRT废液中L-FABP的表达水平。记录28天病死率。结果 A组s L-FABP水平在治疗后48h显著高于治疗前[(1328±101)μg/(g·Cr)比(700±88)μg/(g·Cr),t=5.435,P<0.02)],而B组治疗后48h与治疗前比较s L-FABP水平改变不明显[(680±74)μg/(g·Cr)比(712±82)μg/(g·Cr),t=1.682,P>0.05)];A组u L-FABP水平治疗后48h改变不明显[(1428±124)μg/(g·C)比(1082±89)μg/(g·C),t=4.854,P>0.05)],B组在CRRT治疗后48h u LFABP水平较治疗前显著下降,(1324±123)μg/(g·C)比(1978±88)μg/(g·C),t=2.654,P<0.02)。B组在CRRT治疗48h,s L-FABP水平与A组同期比较显著降低[(680±32)μg/(g·Cr)比(1328±101)μg/(g·Cr),t=3.028,P=0.042],u L-FABP水平与A组同期比较显著下降[(1324±123)μg/(g·Cr)比(1428±124)μg/(g·Cr),t=12.856,P=0.022],s Cr水平与A组同期比较显著下降[(115±12)μmol/L比(295±32)μmol/L,t=8.256,P=0.032]。B组超滤液中未检测出L-FABP表达。结论 CRRT能降低u L-FABP的表达,改善AKI的预后,但并非通过直接清除血中的L-FABP途径。u L-FABP水平可作为CRRT疗效判断的可靠指标。
Objective To investigate the effect of continuous renal replacement therapy（CRRT） on liver-type fatty acid binding proteins（L-FABP） levels in severe sepsis patients with acute kidney injury（AKI）.Methods Sixty-eight severe sepsis associated with AKI patients admitted to the ICU were divided into conventional drug treatment group（group A, n=33） and CRRT group（group B, n=35）. Patients in group A were treat with standard anti-sepsis therapy（SSC protocol, 2012）, and those in group B were treated with CRRT in addition to the standard anti-sepsis therapy. Serum creatinine（s Cr）, serum L-FABP（s L-FABP）, and urinary LFABP（u L-FABP） were measured at 0, 12, 24, and 48 hours after the treatment. In group B, s L-FABP in the ultrafiltrate of CRRT was also measured. Results After 48 hours of the treatment, s L-FABP increased in group A（1328±101 μg/g of Cr vs. 700±88 μg/g of Cr, t=5.435, P〈0.02）, but did not change obviously in group B（680±74 μg/g of Cr vs. 712±82 μg/g of Cr; t=1.682, P〉0.05）; u L-FABP did not change obviously in group A（1428 ± 124 μg/g of Cr vs. 1082 ± 89 μg/g of Cr; t=4.854, P〉0.05）, but decreased significantly in group B（1324±123 μg/g of Cr vs. 1978±88 μg/g of Cr; t=2.654, P〈0.02）. At 12, 24 and 48 hours after the treatment,s L-FABP was significantly lower in group B than in group A（P〈0.05）. No L-FABP cold be detected in ultrafiltrate in group B. Conclusion CRRT induces the decrease of s L-FABP expression, which may improve the prognosis of AKI. CRRT may not remove s L-FABP directly from plasma. s L-FABP level is a reliable indicator to evaluate the therapeutic effectiveness of CRRT.
出处
《中国血液净化》
2016年第1期26-30,共5页
Chinese Journal of Blood Purification
