中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (01): 26-30.doi: 10.3969/j.issn.1671-4091.2016.01.007

• 临床研究 • 上一篇    下一篇

连续性肾脏替代治疗对严重脓毒症急性肾损伤患者尿肝型脂肪酸结合蛋白表达的影响

郝晓萍1 ,邬碧波1 ,张黎明1, 唐琦1, 牛开亚2 ,承解静2   

  1. 1. 上海市闸北区中心医院肾脏内科
    2. 上海中医药大学附属普陀医院急诊重症医学科
  • 收稿日期:2015-09-08 修回日期:2015-11-29 出版日期:2016-01-12 发布日期:2016-05-19
  • 通讯作者: 牛开亚 niukaiya2014@163.com E-mail:niukaiya2014@163.com

Effect of continuous renal replacement therapy on expression of liver-type fatty acid binding proteins (L-FABP) in severe sepsis patients with acute kidney injury

  • Received:2015-09-08 Revised:2015-11-29 Online:2016-01-12 Published:2016-05-19

RichHTML

0

PDF

229

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,sCr)、血L-FABP(serum L-FABP, sL-FABP)、尿L-FABP(urine L-FABP,uL-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sL- 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sL-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uL-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 uLFABP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，sL-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]，uL-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]，sCr 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uL-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。uL-FABP水平可作为CRRT 疗效判断的可靠指标。

关键词: 严重脓毒症, 急性肾损伤, 连续性肾脏替代治疗（CRRT）, 肝型脂肪酸结合蛋白（L-FABP）

Abstract: 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 (sCr), serum L-FABP (sL-FABP), and urinary LFABP (uL-FABP) were measured at 0, 12, 24, and 48 hours after the treatment. In group B, sL-FABP in the ultrafiltrate of CRRT was also measured. Results After 48 hours of the treatment, sL-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); uL-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, sL-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 sL-FABP expression, which may improve theprognosis of AKI. CRRT may not remove sL-FABP directly from plasma. sL-FABP level is a reliable indicator to evaluate the therapeutic effectiveness of CRRT.

Key words: Severe Sepsis, Acute kidney injury, Continuous renal replacement therapy, Liver-type fatty acid binding proteins