叶声,方丽,王迪芬,唐忠平
YE Sheng,FANG Li,WANG Difen,TANG Zhongping

• 1:贵州医科大学
• 2:贵阳市第一人民医院重症医学科
• 3:贵州医科大学附院重症医学科

摘要(Abstract)：

目的:探讨连续肾脏替代治疗(CRRT)对脓毒症急性肾损伤(AKI)患者肾素、血管紧张素Ⅰ(AngⅠ)及醛固酮(ALD)水平的影响。方法:脓毒症AKI患者30例,随机均分常规组和CRRT组,常规组给予原发病、抗感染及补液等常规治疗,CRRT组在常规治疗基础上给予CRRT治疗;2组患者于治疗前、治疗24 h时,分别检测血清肌酐(SCr)、AngⅠ及ALD水平,计算血浆肾素活性(PRA),比较3组患者急性生理—慢性健康状况Ⅱ(APACHEⅡ)评分。结果:治疗前2组患者PRA、AngⅠ、ALD、SCr及APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗24 h时,CRRT组PRA、AngⅠ、ALD、SCr及APACHEⅡ评分均显著低于常规组(P<0.05),CRRT组PRA、AngⅠ、ALD、SCr及APACHEⅡ评分低于治疗前(P<0.05);常规组仅SCr、AngⅠ水平及APACHEⅡ评分低于治疗前(P<0.05)。结论:CRRT在常规治疗脓毒症AKI基础上,CRRT可降低患者PRA、AngⅠ、ALD、SCr水平及APACHEⅡ评分。
Objective: To explore the effects of continuous renal replacement therapy( CRRT) on rennin-angiotensin-aldosterone system( RAAS) of patients with septic associated acute kidney injury( AKI). Methods: 30 patients with septic associated AKI were randomly divided into control group and CRRT group. The control group was treated with conventional therapy such as primary disease,anti-infective,and fluid therapy while CRRT group was treated with CRRT besides conventional therapy. The serum levels of creatinine( SCr),aldosterone( ALD) and angiontensin I for the two groups before treatment and 24 h after treatment. The plasma levels of rennin activity( PRA) were calculated. The acute physiology and chronic health evaluation Ⅱ( APACHE Ⅱ) scores were compared between the two groups. Result: Before treatment there was no statistically significant difference in PRA,AngⅠ,ALD,SCr and scores of APACHE Ⅱ between control group and CRRT group( P > 0. 05).24 h after treatment,PRA,AngⅠ,ALD,SCr and scores of APACHEⅡ in CRRT group were significant lower than their counterparts in control group( P < 0. 05). 24 h after treatment in CRRT group,PRA,AngⅠ,ALD,SCr,scores of APACHE Ⅱwere significantly lower than before treatment( P <0. 05). 24 h after treatment in control group,SCr,Ang Ⅰ,scores of APACHE Ⅱ were significantly lower than before treatment( P < 0. 05),but the other indexes were not significant lower than before treatment( P < 0. 05). Conclusion: CRRT combined with conventional therapy treatment of septic associated AKI can decrease the levels of PRA,AngⅠ,ALD,SCr and APACHEⅡscore.

关键词(KeyWords)： 脓毒症;肾素-血管紧张素-醛固酮系统;急性生理-慢性健康状况Ⅱ评分;急性肾损伤;连续肾脏替代治疗
sepsis;renin-angiotensin-aldosterone system;acute physiology and chronic health evaluationⅡ;acute kidney injury;continuous renal replacement therapy

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 叶声,方丽,王迪芬,唐忠平
YE Sheng,FANG Li,WANG Difen,TANG Zhongping

DOI: 10.19367/j.cnki.1000-2707.2016.08.024

参考文献(References)：

• [1]Lameire N,Van Biesen W,Vanholder R.Acute renal failure[J].Lancet,2005(365):417-430.
• [2]Salgado DR,Rocco JR,Silva E,et al.Modulation of the renin-angiotensin-aldosterone system in sepsis:a new therapeutic approach[J].Expert Opin Ther Targets,2010(1):11-20.
• [3]Doerschug KC,Delsing AS,Schmidt GA,et al.Renin-angiotensin system activation correlates with microvascular dysfunction in a prospective cohort study of clinical sepsis[J].Crit Care,2010(1):24.
• [4]Bridges BC,Askenazi DJ,Smith JA.Pediatric renal replacement therapy in the intensive care unit[J].Blood Purif,2012(2):138-148.
• [5]周立新,谭家驹,李铁男,等.严重脓毒症免疫炎症反应紊乱及双向免疫调节的前瞻性随机对照研究[J].中华医学杂志,2009(15):1028-1033.
• [6]Dellinger RP,Levy MM,Rhodes A,el al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012.Intensive Care Med,2013(2):165-228.
• [7]Khwaja A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clinical Practice,2012(4):179-184.
• [8]肖政辉,易著文.儿童急性肾损伤[J].中国小儿急救医学,2008(1):81-83.
• [9]陈秀凯,李文雄.急性肾损伤的研究进展与回顾[J].中国急救医学,2014(2):111-115.
• [10]Aird WC.The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome[J].Blood,2003(10):3765-3777.
• [11]陆国平,邬惊雷,陆铸今,等.内毒素休克家兔心、肺组织局部血管紧张素系统变化[J].小儿急救医学,2005(5):389-391.
• [12]Tadros T,Traber DL,Heggers JP,et al.AngiotensinⅡinhibitor Du P753 attenuates burn and endotoxin-induced gut ischemia,lipid peroxidation,mucosal permeability,and bacterial Translocation[J].Ann Surg,2000(4):566-576.
• [13]刘玲,邱海波,杨毅,等.血管紧张素Ⅱ-血管紧张素Ⅱ1型受体途径在介导大鼠肺部炎症反应中的作用[J].中华急诊医学杂志,2007(6):601-605.
• [14]朱艳,张育才,肖政辉,等.儿童严重脓毒症连续血液净化治疗时肾素-血管紧张素-醛固酮系统的变化[J].中国小儿急救医学,2015(1):1-4.
• [15]Ruiz-ortega M,Lorenzo O,Ruperez M,et al.Systemic infusion of angiotensin II into normal rats activates nuclear factor-κB and AP-1 in the kidney[J].American Journal of athology,2001(5):1743-1756.
• [16]Cunningham PN,Dyanov HM,Park P,et al.Acute renal failure in endotoxemia is caused by TNF acting directly on TNF receptor-1 in kidney[J].The Journal of Immunology,2002(11):5817-5823.

文章评论(Comment)：