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目的:研究脓毒症并急性肾损伤(AKI)患者检测血清胱抑素(Cys C)对早期诊断的价值及连续性肾脏替代疗法(CRRT)的临床疗效。方法:将2010年1月-2012年12月住院治疗的脓毒症并AKI患者100例随机分为CRRT组及常规治疗组各50例,以同期未合并AKI的普通脓毒症患者50例为对照组,检测确诊后24 h内Cys C;CRRT组在常规治疗组集束化治疗的基础上联合使用CRRT治疗,比较两组治疗前后IL-6,IL-10,TNF-α等炎症因子及.APACHEⅡ评分的变化。结果:脓毒症并AKI的Scr水平虽高于普通脓毒症患者,但并无显著性差异,而Cys C浓度则显著高于未合并AKI患者(P<0.05);CRRT组治疗后各时间点的TNF-α及IL-6均明显下降,且较常规治疗组明显,P<0.05或P<0.01;CRRT组治疗后APACHEⅡ评分显著优于常规治疗组,P<0.05。结论:Cys C在脓毒症并AKI的早期诊断上更敏感、精确,联合CRRT治疗可降低其炎症因子水平,改善预后。
Objective: To study the value of detecting serum cystatin (Cys C) in patients with sepsis and acute kidney injury (AKI) for early diagnosis and the clinical efficacy of continuous renal replacement therapy (CRRT). Methods: One hundred patients with sepsis and AKI admitted to hospital from January 2010 to December 2012 were randomly divided into CRRT group and conventional treatment group, 50 cases each. Fifty patients with normal sepsis without AKI in the same period were Cys C was detected within 24 hours after the diagnosis. The CRRT group was treated with CRRT on the basis of cluster therapy in the conventional treatment group, and the inflammatory factors such as IL-6, IL-10 and TNF-α before and after treatment were compared. APACHE Ⅱ score changes. Results: The Scr levels of sepsis and AKI were higher than those of normal sepsis patients, but there was no significant difference between the two groups (P> 0.05). However, the Cys C concentration was significantly higher than that of patients without AKI (P <0.05) The levels of TNF-α and IL-6 in the CRRT group were significantly lower than those in the conventional treatment group (P <0.05 or P <0.01). The APACHEⅡ score in the CRRT group was significantly better than that in the conventional treatment group (P <0.05). Conclusion: Cys C is more sensitive and accurate in the early diagnosis of sepsis and AKI. Combined with CRRT can reduce the level of inflammatory cytokines and improve the prognosis.