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目的:观察连续性静脉-静脉血液滤过(CVVH)置换剂量和持续时间对急性肾损伤(AKI)患者胱抑素C(CysC)浓度的影响。方法:将AKI伴少尿需行肾脏替代治疗患者纳入研究,予CVVH连续治疗24h以上,根据病情设定置换剂量分别为2L/h或4L/h。于CVVH治疗前及治疗第4、12、24小时抽取滤器前血液,第4小时抽取滤器后血液及超滤液,检测常用肾功能指标即尿素氮(BUN)、肌酐(SCr)和CysC的浓度。比较不同置换剂量和治疗时间点上述各指标的下降率,并计算滤器清除率和浓度时间曲线下面积(AUC)。结果:共纳入15例患者,其中2L/h剂量组7例,4L/h剂量组8例,两组间年龄构成、性别比例均无差异。CVVH治疗前2L/h剂量组BUN、SCr浓度均低于4L/h剂量组(P<0.05),CysC浓度差异无统计学意义。2L/h剂量组CVVH治疗第4、12、24小时滤器前BUN浓度较治疗前分别平均下降13.7%、43.0%、49.5%;SCr浓度分别平均下降12.7%、28.1%、54.5%;CysC浓度分别平均下降8.0%、23.0%、29.3%。CysC浓度下降率均低于同期BUN、SCr浓度下降率(P均<0.05)。2L/h剂量组BUN、SCr和CysC中位清除率分别为23.0ml/min、26.8ml/min和10.4ml/min,AUC分别为0.306mg/(L.h),0.252mg/(L.h),和0.190mg/(L.h)。4L/h剂量组CVVH治疗第4、12、24小时滤器前BUN浓度较治疗前分别平均下降12.3%、33.4%、56.5%,SCr浓度分别平均下降14.5%、29.4%、49.6%,CysC浓度分别平均下降10.2%、17.6%、29.7%。第12和24小时CysC浓度下降率均低于同期BUN、SCr浓度下降率(P均<0.05)。4L/h剂量组对BUN、SCr和CysC中位清除率分别为46.3ml/min、41.8ml/min和21.7ml/min,AUC分别为0.271mg/(L.h)、0.216mg/(L.h)和0.310mg/(L.h)。结论:CVVH置换剂量和持续时间对AKI患者的CysC浓度及清除率的影响均远低于BUN、SCr,提示用其反映肾功能的变化相对更为可靠。
Objective: To observe the effects of continuous venovenous hemofiltration (CVVH) replacement dose and duration on the concentration of cystatin C (CysC) in patients with acute kidney injury (AKI). Methods: Patients with AKI with oliguria undergoing renal replacement therapy were enrolled in the study. Patients were treated with CVVH for more than 24 hours. The replacement doses were 2L / h or 4L / h, respectively. Pre-filter blood was collected before CVVH treatment and at 4, 12, and 24 hours after treatment, and blood and ultrafiltrate were collected after 4 hours of filtration. The concentrations of BUN, SCr and CysC . The rate of decline of each index above was compared at different dose and time of treatment, and the area under the curve of filter clearance and concentration time (AUC) was calculated. Results: A total of 15 patients were enrolled, including 7 cases in 2 L / h dose group and 8 cases in 4 L / h dose group. There was no difference in age composition and sex ratio between the two groups. The concentrations of BUN and SCr in 2 L / h dose group before CVVH treatment were all lower than those in 4 L / h dose group (P <0.05), and there was no significant difference in CysC concentration. The concentration of BUN in pre-treatment 2, 12, and 24 hours of CVVH treatment decreased by 13.7%, 43.0% and 49.5% respectively on average; the SCr concentrations decreased by 12.7%, 28.1% and 54.5% The average decrease of 8.0%, 23.0%, 29.3%. The decrease rate of CysC concentration was lower than that of BUN and SCr in the same period (all P <0.05). The median clearance rates of BUN, SCr and CysC in 2L / h group were 23.0ml / min, 26.8ml / min and 10.4ml / min, respectively. The AUC values were 0.306mg / Lh, 0.252mg / Lh and 0.190 mg / (Lh). The BUN concentration of 4, 12 and 24 hours before treatment decreased by 12.3%, 33.4% and 56.5% on average in the 4,12 h and 24 h / h CVVH treatment groups, respectively. The SCr concentrations decreased by 14.5%, 29.4% and 49.6% The average drop of 10.2%, 17.6%, 29.7%. The decreasing rates of CysC concentration at 12 and 24 hours were lower than that of BUN and SCr at the same period (all P <0.05). The median clearance rates of BUN, SCr and CysC in 4L / h group were 46.3ml / min, 41.8ml / min and 21.7ml / min, respectively, and the AUC were 0.271mg / Lh, 0.216mg / Lh and 0.310 mg / (Lh). CONCLUSIONS: The effect of CVVH replacement dose and duration on CysC concentration and clearance rate in patients with AKI is much lower than that of BUN and SCr, suggesting that the changes of renal function are relatively more reliable.