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脓毒症AKI患者Cys C、GFR和循环RAAS水平变化与预后的相关性
叶声,唐忠平,林凤,管亚慧,刘璇,李昕建,方丽
0
(贵阳市第一人民医院重症医学科)
摘要:
目的 探讨连续肾脏替代治疗(CRRT)对脓毒症急性肾损伤患者(AKI)血清胱抑素C(CysC)、肾小球滤过率(GFR)和循环肾素血管紧张素醛固酮系统(RAAS)水平变化的影响及其与预后的相关性。方法 选取2016年9月~2018年10月我院收治的脓毒症AKI患者76例为研究对象,其中,21例死亡者为病例组,55例存活者为存活组。比较两组治疗前和治疗后3 d时Cys C、GFR、循环RAAS水平与急性生理和慢性健康评分(APACHEⅡ)的变化,并作Cys C、GFR和循环RAAS水平与APACHEⅡ评分的相关性及预后的危险因素分析。结果 治疗后,存活组Cys C、PRA、AngⅠ水平及APACHEⅡ评分均低于病例组,GFR高于病例组,差异均有统计学意义(均P<0.05);Cys C、PRA、AngⅠ均与APACHEⅡ评分呈正相关(r=0.602,0.524,0.485,P<0.05),GFR与APACHEⅡ评分呈负相关(r=-0.664,P<0.05);经单因素和多因素Logistic回归分析结果显示,Cys C、PRA、AngⅠ和APACHEⅡ评分是影响脓毒症AKI预后的危险因素,GFR是影响脓毒症AKI预后的保护因素(P<0.05)。 结论 CRRT治疗脓毒症AKI患者可有效降低Cys C、PRA、AngⅠ水平,升高GFR水平,且以上指标与患者预后密切相关,是影响预后的重要因子。
关键词:  脓毒症  急性肾损伤  RAAS  Cys C  预后
DOI:
基金项目:贵州省科技厅科学技术基金([2014]7335);贵阳市科学技术局基金([20161001]10
Correlation between changes of levels of Cys C, GFR and circulating RAAS and prognosis of patients with sepsis and AKI
YE Sheng,TANG Zhongping,LIN Feng,GUAN Yahui,LIU Xuan,LI Xinjian,FANG Li
(Intensive Care Unit, The First People′s Hospital of Guiyang)
Abstract:
Objective To investigate the effects of continuous renal replacement therapy (CRRT) on levels of serum cystatin C (CysC), glomerular filtration rate (GFR) and circulating reninangiotensinaldosterone system (RAAS) of patients with sepsis and acute kidney injury (AKI) and their relationships with prognosis. Methods 76 patients with sepsis and AKI admitted to the hospital from September 2016 to October 2018 were enrolled in the study. They were randomly divided into observation group (n=38) and control group (n=38), according to the random number table method. The control group was given routine treatment. On this basis, the observation group was treated with CRRT. The changes of levels of Cys C, GFR, circulating RAAS and scores of acute physiology and chronic health evaluation (APACHE Ⅱ) in the two groups before treatment and at 3 days after treatment were compared. Correlation between levels of Cys C, GFR, circulating RAAS and APACHE Ⅱ scores and risk factors of prognosis were analyzed. Results After treatment, the levels of Cys C, PRA, AngⅠ, ALD and scores of APACHE Ⅱ in the observation group were lower than those in the control group, while the GFR level was higher than that in the control group (P<0.05). There were 55 casessurvived in the two groups undergoing treatment for 28 days. The levels of Cys C, PRA, AngⅠ and scores of APACHEⅡ of survivors were lower than those of dead patients, while the GFR level was higher than that of dead patients (P<0.05). Cys C, PRA and AngⅠ were positively correlated with APACHE Ⅱ scores (r=0.602, r=0.524, r=0.485,P<0.05), while GFR was negatively correlated with APACHEⅡ scores (r=-0.664, P<0.05). Univariate and multivariate Logistic regression analysis showed that Cys C, PRA, AngⅠand APACHE Ⅱ scores were risk factors affecting the prognosis of patients with sepsis and AKI, while GFR was a protective factor affecting the prognosis of patients with sepsis and AKI (P<0.05).Conclusion CRRT for patients with sepsis and AKI can effectively reduce the levels of Cys C, PRA, AngⅠ and increase the level of GFR. And the above indicators are closely related to the prognosis of patients, which are important factors affecting prognosis.
Key words:  Sepsis  Acute kidney injury  RAAS  Cys C  Prognosis

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