乌司他丁治疗蜂蜇伤后急性肾损伤的救治分析

摘要

目的 研究乌司他丁对蜂蜇伤后急性肾损伤(AKI)的疗效及其机制.方法 将我科59例患者随机分为对照组(29例)和治疗组(30例),两组给予常规治疗,治疗组在此基础上加用乌司他丁,疗程7 d.观察两组患者死亡率和痊愈率、少尿期持续时间,并观察治疗前和治疗7 d后急性生理学与慢性健康状况评分(APACHE)Ⅱ、血肌酐(Scr)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)、血浆肿瘤坏死因子(TNF) α、白介素(IL)-1β和IL-10的水平.结果 两组患者死亡率比较,差异无统计学意义(P＞0.05),治疗组痊愈率高于对照组(93.1% vs.71.4%,P=0.041),少尿期持续时间治疗组短于对照组[(21.8±2.7)d vs.(24.8±2.6)d,P=0.0001].治疗前两组患者APACHE Ⅱ、Scr、NAG、TNF-α、IL-1β和IL-10水平差异无统计学意义(P＞0.05);治疗7 d后,治疗组APACH Ⅱ[(9.46±1.43)vs.(11.04±1.84)]、Scr[404.3(366.4,470.0)vs.522.4(438.9,574.7)μmol/L]、NAG[(40.77±10.87)vs.(49.49±16.23)U/L]、TNF-α[(112.62±32.37)vs.(141.76±53.44)μg/L]和IL-1β[(18.01±6.25)vs.(22.04±5.17)pg/ml]水平均较对照组低,差异有统计学意义(P＜0.05),IL-10水平较对照组高[(75.35±12.38)vs.(68.56±11.01)pg/ml],差异有统计学意义(P＜0.05).结论 乌司他丁通过减轻肾小管损伤、下调TNF-α、IL-1β水平和上调IL-10水平,减轻毒蜂蜇伤后AKI.%Objective To study the effect of ulinastatin on acute kidney injury ( AKI ) and its mechanism following wasp stings. Methods Fifty - nine patients were divided randomly into groups control ( n =29 ) and treatment ( n = 30 ). Two groups were treated with conventional therapy, but treatment group with additional ulinastatin injection. Mortality, recovery rates, duration of oliguria observed, and the scores of Acute Physiology and Chronic Health Evaluation ( APACHE ) Ⅱ, levels of serum creatinine ( scr ), urinary N - acetyl - β - glucosaminidase ( NAG ), tumor necrosis factor - α ( TNF - α ), interleukin ( IL) - 1 β and IL - 10 compared between 2 groups before treatment and 7 days after. Results No significant difference was noted in mortality between 2 groups ( P > 0. 05 ). Recovery rate was higher in group treatment than in control ( 93. 1% vs. 71.4%, P =0.041), and duration of oliguria shorter [ (21. 8 ±2. 7) vs. (24. 8 ±2. 6) d, respectively, P =0.0001]. There was not significant difference in APACHE II , Scr, NAG, TNF - α, IL - lβ, IL - 10 between 2 groups before treatment ( P >0. 05 ). And 7 d after, treatment group were lower than control in APACH Ⅱ scores ( 9. 46 ± 1. 43 ) vs ( 11. 04 ± 1. 84 ), Scr [ 404. 3 ( 366. 4, 470. 0 ) vs. 522. 4 ( 438. 9, 574. 7 ) μmol/L ], NAG [ ( 40. 77 ± 10. 87 ) vs. ( 49. 49 ± 16. 23 ) U/ L ], TNF - α [ ( 112.62 ± 32. 37 ) vs. ( 141. 76 ± 53. 44 ) μg/L ] and IL - 1 β [ ( 18. 01 ± 6. 25 ) vs. ( 22. 04 ± 5. 17 ) pg/ ml ], the difference was significant ( P <0. 05 ), and higher in IL - 10 [ ( 75. 35 ± 12. 38 ) vs. ( 68. 56 ± 11. 01 ) pg/ml, P <0. 05 ]. Conclusion Ulinastatin can alleviate AKI following wasp stings by reducing renal tubule damage, down - regulating TNF - α and IL - 1 β and up - regulating IL - 10.