连续静脉-静脉血液滤过对脓毒症急性肾损伤中性粒细胞明胶酶相关脂质运载蛋白的影响

摘要

目的 探讨连续静脉-静脉血液滤过(CVVH)是否影响脓毒症急性肾损伤(SAKI)患者的血浆中性粒细胞明胶酶相关脂质运载蛋白(pNGAL)水平.方法 42例需行CVVH的SAKI患者,测定CVVH前(T0)、CVVH开始后2 h(T2)、4h(T4)、8h(T8)、12 h(T12)留取动脉端、静脉端、超滤液标本的NGAL水平.根据质量守恒定律计算中性粒细胞明胶酶相关脂质运载蛋白(NGAL)质量转移率(Mtr)、质量吸附率(Mad)、血浆清除率(PC)、筛选系数(SC).结果 CVVH过程中,动脉端和静脉端的pNGAL水平未发生明显改变(P＞0.05),而超滤液中NGAL逐渐下降(P=0.013).Mtr、Mad和PC未发生明显变化(P＞0.05).随CVVH时间延长,SC逐渐下降(P=0.007).结论 CVVH清除pNGAL的能力有限.因此,临床在行CVVH过程中使用pNGAL评估肾功能进展时可不考虑CVVH的影响.%Objective To evaluate whether continuous venovenous hemofiltration (CVVH) affect the plasma level of neutrophil gelatinase-associated lipocalin (pNGAL) in patients with sepsis-acute kidney injury (SAKI).Methods A total of 42 patients with sepsis-induced AKI undergoing CVVH were screened.NGAL was measured in the prefilter and postfilter blood as well as in the ultrafiltrate at the beginning of continuous renal replacement therapy (CRRT) (T0) and 2 h (T2h),4 h (T4h),8 h (T8h),and 12 h (T12h) after the setup of CRRT.The mass conservation principle was used for calculating the mass transfer,plasma clearance,and sieving coefficient.Results The levels of NGAL at the inlet and outlet did not change following the initiation of CVVH (P＞0.05),whereas in the ultrafiltrate,the concentrations decreased significantly (P=0.013).The total mass removal rate,total mass adsorption rate,and plasma clearance remained unchanged over time (P＞0.05),and the sieving coefficient decreased significantly (P=0.007).Conclusions The impact of CVVH on pNGAL in patients with sepsis-induced AKI is limited.Therefore,it does not need to be taken into account when pNGAL is used for evaluating renal progression in patients with septic AKI undergoing CVVH.