连续性血液净化配合固本泄浊化瘀汤治疗急性肾损伤的疗效及KIM-1与NGAL表达水平的影响

The effect of continuous blood purification combined with Guben Xiezhuo Huayu Decoction on acute kidney injury and its effect on KIM-1 and NGAL expression

关键词:  连续性血液净化  固本泄浊化瘀汤  急性肾损伤  疗效

Key words:  continuous renal replacement therapy  Guben Xiezhuo Huayu Decoction  acute kidney injury  the curative effect

摘要:

[目的] 探究与分析连续性血液净化配合固本泄浊化瘀汤治疗急性肾损伤的疗效及对人肾损伤分子1（KIM-1）与中性粒细胞明胶酶相关载脂蛋白（NGAL）表达水平的影响。[方法] 选取自2016年5月—2018年5月收治的急性肾损伤患者132例，采取随机数字表法分为对照组66例与观察组66例，对照组给予连续性血液净化治疗，观察组加用固本泄浊化瘀汤治疗，对比两组临床疗效、炎性因子、血流动力学指标水平变化及血肌酐、尿素氮、内生肌酐清除率、KIM-1及NGAL表达水平、急性生理学评分和慢性健康状况评分Ⅱ（APACHE Ⅱ）评分变化、住院时间及病死率。[结果] 观察组与对照组相比临床总有效率较高，差异具有统计学意义（P<0.05）。两组患者治疗后与治疗前相比肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及超敏C-反应蛋白（hs-CRP）均降低，平均动脉压（MAP）升高，心脏指数（CI）降低，心率（HR）降低，全身血管阻力指数（SVRI）升高，血肌酐降低，尿素氮降低，内生肌酐清除率升高，KIM-1及NGAL表达水平均降低，APACHE Ⅱ评分降低，观察组治疗后与对照组治疗后相比上述指标改善更加显著，差异具有统计学意义（P<0.05）。观察组治疗后APACHE Ⅱ评分更低，差异具有统计学意义（P<0.05）。观察组与对照组相比，住院时间、病死率降低无明显差异（P>0.05）。[结论] 采用连续性血液净化治疗急性肾损伤的基础上加用固本泄浊化瘀汤治疗能够获得较好的临床疗效，减少炎症反应，改善各指标的表达水平，降低病死率。

Abstract:

[Objective] To explore and analyze the curative effect of continuous blood purification combined with Guben Xiezhuo Huayu Decoction in the treatment of acute renal injury and the effect on the expression levels of KIM-1 and NGAL.[Methods] The 132 cases of patients with acute kidney injury selected form May 2016 to May 2018 were treated in our hospital all the patients took a random number table method were divided into the control group (n=66) and the observation group (n=66),the control group was given continuous blood purification treatment,the observation group used Guben Xiezhuo Huayu Decoction,compared two groups of clinical curative effect,inflammatory factor,hemodynamic indexes and serum creatinine level change,KIM-1 and NGAL expression level,acute physiology score and chronic health evaluation Ⅱ (APACHE Ⅱ)score change,length of hospital stay and mortality.[Results] The total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant (P<0.05). TNF-α,IL-6,and hs-CRP were lower in both groups after treatment than in pre-treatment,MAP increased,CI decreased,HR decreased,SVRI increased,serum creatinine decreased,urea nitrogen decreased,and endogenous creatinine clearance The rate of KIM-1 and NGAL decreased,and the APACHE II score decreased. The improvement of the above treatment was more significant after treatment in the observation group than in the control group,and the difference was statistically significant (P<0.05). The APACHE II score was lower in the observation group after treatment,and the difference was statistically significant (P<0.05). There was no significant difference in the mortality of the observation group compared with the control group (P>0.05).[Conclusion] The application of continuous blood purification in the treatment of acute renal injury combined with the treatment of Guben Xiezhuo Huayu Decoction can achieve better clinical efficacy,reduce inflammatory response,improve the expression level of each index and to reduce mortality.