Objective To compare the impact on renal function of patients with severe stroke in different doses of ulinastatin. Methods From April 2014 to April 2016,a total of 53 patients with severe stroke were selected in the Central Hospital of Chancheng District,Foshan,and they were randomly divided into control group(n = 20),A group(n = 16)and B group(n = 17). Patients of control group received conventional treatment,meanwhile patients of A group received extra low dose of ulinastatin(50 000 U,3 times per day)based on conventional treatment,while patients of B group received extra high dose of ulinastatin(200 000 U,3 times per day)based on conventional treatment;all of the three groups continuously treated for 7 days. Index of renal function(including BUN,Cr and β2 - microglobulin)and inflammatory cytokines(including TNF-αand IL-6)on the first,second,third and fifth day of treatment,incidence of AKI,therapeutic condition of hemopurification and fatality rate were compared among the three groups. Results There was no interaction between time and method in BUN(P﹥ 0. 05),while there were interaction between time and method in Cr and β2 - microglobulin(P ﹤ 0. 05);the main effect of time or method was not significant in BUN,Cr or β2 - microglobulin(P ﹥ 0. 05);on the fifth day of treatment,BUN,Cr and β2 - microglobulin of B group were statistically significantly lower than those of control group and A group(P ﹤ 0. 05). There was interaction between time and method in TNF-α and IL-6(P ﹤ 0. 05);the main effect of time was significant in TNF-α and IL-6(P ﹤ 0. 05),while the main effect of method was not significant in TNF-α or IL-6(P ﹥ 0. 05);on the third and fifth day of treatment,TNF-α and IL-6 of B group were statistically significantly lower than those of control group and A group( P ﹤0. 05). The incidence of AKI of B group was statistically significantly lower than that of control group and A group,respectively (P ﹤ 0. 05). No statistically significant differences of proportion of patients undergoing hemopurification or fatality rate was found among the three groups(P ﹥ 0. 05). Conclusion High dose of ulinastatin has better protective effect on renal function than low dose of ulinastatin,can more effectively reduce the incidence of AKI and improve the prognosis.%目的：比较不同剂量乌司他丁对重症脑卒中患者肾功能的影响。方法选取2014年4月—2016年4月佛山市禅城区中心医院重症医学科收治的重症脑卒中患者53例，随机分为对照组20例、低剂量组16例、高剂量组17例。对照组患者予以常规治疗，低剂量组患者在常规治疗基础上予以低剂量乌司他丁（5万 U，3次/ d）治疗，高剂量组患者在常规治疗基础上予以高剂量乌司他丁（20万 U，3次/ d）治疗；3组患者均连续治疗7 d。比较3组患者治疗第1、2、3、5天肾功能指标（尿素氮、肌酐、β2-微球蛋白）和炎性因子〔肿瘤坏死因子α（TNF-α）、白介素6（IL-6）〕及急性肾损伤（AKI）发生情况、血液净化治疗情况、死亡情况。结果时间与方法在尿素氮上无交互作用（P ﹥0.05），时间与方法在肌酐、β2-微球蛋白上存在交互作用（P ﹤0.05）；尿素氮、肌酐和β2-微球蛋白在时间和方法上主效应不显著（P ﹥0.05）；治疗第5天高剂量组患者尿素氮、肌酐、β2-微球蛋白水平低于对照组、低剂量组（P ﹤0.05）。时间与方法在TNF-α、IL-6上存在交互作用（P ﹤0.05）；TNF-α、IL-6在时间上主效应显著（P ﹤0.05）；TNF-α、IL-6在方法上主效应不显著（P ﹥0.05）；治疗第3、5天高剂量组患者TNF-α、IL-6水平低于对照组、低剂量组（P ﹤0.05）。高剂量组患者 AKI 发生率低于对照组、低剂量组（P ﹤0.05）。3组患者行血液净化治疗者所占比例、病死率比较，差异无统计学意义（P ﹥0.05）。结论高剂量乌司他丁对重症脑卒中患者肾功能的保护作用优于低剂量乌司他丁，可更有效地减少 AKI 的发生，改善患者预后。
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