王翔, 张志敏, 李建国, 宋亚君. CRRT与IHD治疗对脓毒症合并急性肾损伤患者尿IGFBP-7、NGAL及TIMP-2水平影响的比较[J]. 临床肾脏病杂志, 2022, 22(2): 94-99. DOI: 10.3969/j.issn.1671-2390.2022.02.002
    引用本文: 王翔, 张志敏, 李建国, 宋亚君. CRRT与IHD治疗对脓毒症合并急性肾损伤患者尿IGFBP-7、NGAL及TIMP-2水平影响的比较[J]. 临床肾脏病杂志, 2022, 22(2): 94-99. DOI: 10.3969/j.issn.1671-2390.2022.02.002
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    WANG Xiang, ZHANG Zhi-min, LI Jian-guo, SONG Ya-jun. Differences in efficacies of continuous renal replacement therapy and intermittent hemodialysis upon urinary levels of insulin-like growth factor binding protein 7,neutrophil gelatinase-associated lipocalin and tissue inhibitor of metalloproteinase-2 in se[J]. Journal of Clinical Nephrology, 2022, 22(2): 94-99. DOI: 10.3969/j.issn.1671-2390.2022.02.002
    Citation: WANG Xiang, ZHANG Zhi-min, LI Jian-guo, SONG Ya-jun. Differences in efficacies of continuous renal replacement therapy and intermittent hemodialysis upon urinary levels of insulin-like growth factor binding protein 7,neutrophil gelatinase-associated lipocalin and tissue inhibitor of metalloproteinase-2 in se[J]. Journal of Clinical Nephrology, 2022, 22(2): 94-99. DOI: 10.3969/j.issn.1671-2390.2022.02.002
    shu

    CRRT与IHD治疗对脓毒症合并急性肾损伤患者尿IGFBP-7、NGAL及TIMP-2水平影响的比较

    Differences in efficacies of continuous renal replacement therapy and intermittent hemodialysis upon urinary levels of insulin-like growth factor binding protein 7,neutrophil gelatinase-associated lipocalin and tissue inhibitor of metalloproteinase-2 in se

      摘要
    • 摘要: 目的 探究连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)与间歇性血液透析(intermittent hemodialysis,IHD)治疗对脓毒症合并急性肾损伤患者尿胰岛素样生长因子结合蛋白7(insulin-like growth factor-binding protein-7,IGFBP-7)、组织金属蛋白酶抑制物-2(tissue inhibitor of metalloproteinase-2,TIMP-2)及血中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平的影响。方法 选取2015年1月至2019年1月国药东风总医院收治的100例脓毒症合并急性肾损伤患者,根据患者治疗方式分为观察组和对照组各50例。观察组患者接受CRRT治疗,对照组患者接受IHD治疗。所有患者在治疗期间均完善其心脏功能检查、血清炎症因子以及肾功能检查。分析两组患者尿IGFBP-7、TIMP-2及NGAL水平的差异;比较两组患者治疗前后心功能指标:平均动脉压、左室射血分数、心脏指数、心输出量;炎症因子指标:C反应蛋白、白细胞计数、降钙素原,肾功能指标:血尿素氮和血肌酐,以及APACHEⅡ的差异。结果 观察组患者尿量恢复时间、器官支持时间、ICU住院时间以及心血管事件发生率均明显低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组左室射血分数、心脏指数、心输出量均明显高于对照组,差异有统计学意义(P<0.05)。两组患者C反应蛋白、白细胞计数、降钙素原、血尿素氮、血肌酐以及APACHEⅡ均明显低于治疗前,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组治疗后的尿IGFBP-7、TIMP-2及NGAL水平均明显低于治疗前,且显著低于对照组,差异有统计学意义(P<0.05)。结论 CRRT较IHD治疗脓毒症合并急性肾损伤的临床疗效更显著,可有效缩短患者ICU住院时间,改善尿IGFBP-7、TIMP-2及NGAL水平,值得在临床推广应用。

       

      Abstract: Objective To explore the efficacies of continuous renal replacement(CRRT) versus intermittent hemodialysis(IHD) for urinary insulin-like growth factor binding protein 7(IGFBP-7) and tissue inhibitor of metalloproteinase-2(TIMP-2) and compare the differences in blood levels of neutrophil gelatinase-associated lipocalin(NGAL) in septic patients with acute kidney injury(AKI).Methods From January to September 2019,100 hospitalized septic patients with AKI were divided into two groups of observation and control according to specific treatment mode(n=50 each). Observation group underwent CRRT while control group had IHD. All cardiac function tests were completed and blood biochemical parameters detected during treatment. The inter-group differences of urinary levels of IGFBP-7,TIMP-2 and NGAL were analyzed. For comparing two groups pre/post-treatment,mean arterial pressure(MAP),left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac output(CO),inflammatory factor parameters of C-reactive protein(CRP),white blood count(WBC),procalcitonin(PCT),renal function parameters of blood urea nitrogen(BUN) and serum creatinine(Scr) and differences of APACHE Ⅱ were recorded.Results The recovery time of urinary volume,organ support time,intensive care unit(ICU) stay and incidence rate of cardiovascular events were significantly lower in observation group than those in control group. And the differences had statistical significance(P<0.05). After treatment,LVEF,CI and CO were significantly higher in observation group than those in control group and the differences had statistical significance(P<0.05). CRP,WBC,PCT,BUN,Scr and APACHE II were significantly lower in both groups than thosepre-treatment. And observation group was significantly lower than control group and the differences were statistically significant(P<0.05). The urinary levels of IGFBP-7,TIMP-2 and NGAL were significantly lower in observation group posttreatment than those pre-treatment. All were significantly lower than those in control group and the differences had statistical significance(P<0.05).Conclusions More effective than IHD in the treatment of sepsis with AKI,CRRT can effectively shorten ICU stay and improve the urinary levels of IGFBP-7,TIMP-2 and NGAL. It is worthy of wider clinical applications.

       

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