脓毒症相关急性肾损伤患者肾功能转归的临床研究

发布时间：2018-04-13 13:39

  本文选题：脓毒症 + 急性肾损伤　； 参考：《首都医科大学》2017年硕士论文

【摘要】：目的了解脓毒症相关急性肾损伤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。方法前瞻性选取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急性肾损伤(acute kidney injury,AKI)患者,观察其28天及90天肾功能及临床转归,纳入患者一般指标、入组即刻生化、血常规、危重症评分、血尿中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、金属蛋白酶组织抑制因子-2(Tissue inhibitor of metalloproteinase-2,TIMP2)、胰岛素样生长因子结合蛋白-7(Insulin-like growth factor binding protein-7,IGFBP-7)、肝型脂肪酸结合蛋白(liver fatty acid binding protein,LFABP)。根据90天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(receiver operating characteristic curve,ROC)下面积及Logistic回归分析评估这些因素对需行连续肾脏替代疗法(continuous renal replacement therapy,CRRT)的AKI患者的预后价值。结果本课题共纳入49名患者,其中男性29名,女性患者20名。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24h APACHE-II评分、肾外器官SOFA评分、KDIGO分期、脏衰器官个数≥3个、血小板计数、乳酸水平、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TIMP-2、血NGAL、血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、脏衰个数、急性生理和慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHE-II)评分、全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,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1.患者年龄、有心功能不全及高血压疾病史、诊断脓毒症AKI后24h APACHE-II评分、肾外器官SOFA评分、KDIGO分期、脏衰器官个数≥3个、血小板计数、乳酸水平、肺部感染、合并呼吸衰竭、少尿、机械通气、应用血管活性药物均与肾功能预后有关,其中APACHE-II评分、SOFA评分可有效预测肾功能恢复。2.脓毒症AKI诊断即刻血NGAL、尿TIMP-2水平对肾功能恢复有预测价值。
[Abstract]:Objective to investigate the outcome of renal function and its related factors in patients with acute renal injury associated with sepsis, and to provide theoretical basis for clinical prevention and treatment of acute renal injury.Methods from January 2016 to December 2016, patients with septic acute kidney injury were enrolled in the Department of intensive Medicine, Beijing Friendship Hospital affiliated to Capital Medical University, and their renal function and clinical outcome were observed 28 and 90 days later.Including general indexes of patients, immediate biochemistry, blood routine, critical illness score,According to the outcome of renal function in 90 days, the patients were divided into two groups: the recovery group and the unrecovered group. The early predictive factors were analyzed by comparing the two groups.The area under receiver operating characteristic (characteristic) and Logistic regression analysis were used to evaluate the prognostic value of these factors in AKI patients who needed continuous renal replacement therapy.Results A total of 49 patients were included in this study, including 29 males and 20 females.The recovery rate of renal function in patients with sepsis-related AKI was 49. Pulmonary infection was the most common source of infection.Baseline level contrast indicated that age, history of cardiac insufficiency and hypertension, 24 h APACHE-II score after diagnosis of sepsis, SOFA score of extrarenal organ and KDIGO stage, number of organ of visceral failure 鈮，

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