脓毒症相关急性肾损伤患者肾功能转归的临床研究

doi:10.3969/j.issn.1006-7795.2018.01.005

摘要/Abstract

摘要： 目的了解脓毒症相关急性肾损伤（acute kidney injury，AKI）患者肾脏功能转归及相关影响因素，为急性肾损伤临床防治提供理论依据。方法选取2016年1月至2016年12月进入首都医科大学附属北京友谊医院重症医学科的脓毒性AKI患者，观察其28 d及90 d肾功能及临床转归。根据90 d肾功能转归将患者分为肾功能恢复组及肾功能未恢复组，通过两组间对比，分析有统计学意义的早期预测因素，运用受试者工作特征曲线下面积及Logistic回归分析评估这些因素对需行连续性肾脏替代治疗的AKI患者的预后价值。结果共纳入49名患者，肾功能恢复组24人，肾功能未恢复组25人。整体脓毒症相关AKI患者肾功能恢复率为49%，感染来源以肺部感染最常见。基线水平对比提示年龄、有心功能不全及高血压疾病史、诊断脓毒症AKI后24 h急性生理和慢性健康评分Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）、肾外器官全身性感染相关性器官功能衰竭评分（epsis-related Organ Failure Assessment，SOFA）、改善全球肾脏病预后组织（Kidney Disease Improving Global Outcomes，KDIGO）分期、脏器衰竭个数 ≥ 3个、血小板计数、乳酸浓度、肺部感染、合并呼吸衰竭、少尿、机械通气、应用血管活性药物、入组即刻尿组织金属蛋白酶抑制剂-2（tissue inhibitor of metalloproteinase-2，TIMP-2）、血中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin，NGAL）、血肝脂肪酶结合蛋白（liver fatly acid binding protein，LFABP）浓度与肾功能恢复有关。Logistic回归模型分析显示影响脓毒症AKI患者肾功能恢复的因素有机械通气、脏器衰竭个数、APACHE Ⅱ评分、KDIGO分期、少尿、低蛋白血症、血NGAL、尿TIMP-2。其中APACHE Ⅱ评分、肾外脏器SOFA评分、血NGAL、尿TIMP-2对肾功能恢复有较好的预测价值。结论患者的APACHE Ⅱ评分、肾外SOFA评分、脓毒症AKI诊断即刻血NGAL、尿TIMP-2浓度可有效预测肾功能恢复。

关键词: 脓毒症, 急性肾损伤, 肾功能转归

Abstract: Objective To study the renal and clinical prognosis of patients with sepsis-related acute kidney injury (AKI), aiming to analyze the related influencing factors of renal recovery.Methods Sepsis-related AKI patients were prospectively selected in intensive care unite (ICU) of Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2016, their renal function and clinical outcomes were observed at 28 and 90 days. The patients were divided into renal function recovery group and renal function non-recovery group according to the outcome of the 90 day. By comparing the two groups, the early predictors of renal function outcome were summarized. Logistic regression and area under curve (AUC) of receiver operating characteristic(ROC) curve of these factors were used to evaluate the value in predicting prognosis.Results Totally 49 cases were enrolled into the research, 24 of the recovery group, and 25 of the non-recovery group. The recovery rate of renal function was 49% and the most common source of infection is lung infection in ICU. According to the comparison of variables between the two groups, that renal recovery rate is infected with age, cardiac insufficiency and hypertension, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Sepsis-related Organ Failure Assessment (SOFA) Score excepting kidney, stage of Kidney Disease Improving Global Outcomes (KDIGO), numbers of organ failure, number of platelets, blood lactate, pneumonia, respiratory failure, oliguria, mechanical ventilation, vasoactive drugs and urinary tissue inhibitor of metalloproteinase-2 (TIMP-2), blood neutrophil gelatinase-associated lipocalin (NGAL), blood liver fatly acid binding protein (LFABP) of patients into the research immediately. Logistic regression analysis model showed that the influence factors of sepsis-related AKI patients are mechanical ventilation, APACHEⅡ score, stage of KDIGO, oliguria, hypoproteinemia, blood NGAL, urinary TIMP-2. APACHEⅡ, SOFA score excepting kidney, blood NGAL, urinary TIMP-2 are related to the AKI recovery.Conclusion APACHEⅡ score and SOFA score excepting kidney,blood NGAL and urinary TIME-2 after sepsis diagnosed immediately have predictive value of renal function recovery.

Key words: sepsis, acute kidney injury, renal recovery

中图分类号:

R692

于淑婧, 刘培, 林瑾, 刘景峰, 冀晓俊, 刘壮, 董磊, 段美丽. 脓毒症相关急性肾损伤患者肾功能转归的临床研究[J]. 首都医科大学学报, 2018, 39(1): 21-27.

Yu Shujing, Liu Pei, Lin Jin, Liu Jingfeng, Ji Xiaojun, Liu Zhuang, Dong Lei, Duan Meili. Clinical study of renal function recovery in sepsis-related acute kidney injury patients[J]. Journal of Capital Medical University, 2018, 39(1): 21-27.

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