论文部分内容阅读
目的探讨肾脏损伤分子1(KIM-1)在指导心肾综合征患者袢利尿剂与噻嗪类利尿剂合用是否有利于增强利尿效果和保护肾功能。方法将75例心肾综合征患者随机分为两组,对照组35例依据体重+NYHA心功能分级进行用药,实验组40例依据尿液KIM-1水平指导用药,测量连续最低药量维持1个月后血清肌酐、胱抑素C和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿液KIM-1的变化,并比较两组并发症发生率。结果使用利尿剂前至开始使用最低药量维持时,两组血清肌酐、胱抑素C、NGAL和尿液KIM-1水平均有所下降,其中实验组上述指标下降程度尤为明显,与对照组比较差异有统计学意义(P<0.05),连续最低药量维持1个月后,指导组血清肌酐、胱抑素C、NGAL和尿液KIM-1均明显下降,且均明显低于对照组,差异有统计学意义(P<0.05);实验组低血钾和脱水发生率低于对照组,但差异无统计学意义(P>0.05)。结论根据KIM-1水平调整袢利尿剂与噻嗪类利尿剂合用剂量有利于增强心肾综合征患者的利尿效果,更有利于患者肾功能的保护。
Objective To investigate whether renal injury molecule 1 (KIM-1) can improve diuretic effect and protect renal function in patients with cardiorenal syndrome and diuretics. Methods Seventy-five patients with cardio-renal syndrome were randomly divided into two groups. 35 patients in the control group were treated according to the weight and NYHA functional class. Forty patients in the experimental group were given medication according to the urine KIM-1 level. The continuous minimum dose was maintained at 1 Month after the serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin (NGAL) and urine KIM-1 changes, and compared the incidence of complications in both groups. Results The levels of serum creatinine, cystatin C, NGAL and urine KIM-1 in both groups decreased with the minimum dose of diuretic administered until the beginning of the maintenance period. The level of KMI-1 in the two groups was significantly decreased, especially in the control group (P <0.05). Serum creatinine, cystatin C, NGAL and urine KIM-1 in the guide group were significantly lower than those in the control group after the continuous minimum dose was maintained for 1 month , The difference was statistically significant (P <0.05). The incidence of hypokalemia and dehydration in the experimental group was lower than that in the control group, but the difference was not statistically significant (P> 0.05). Conclusions Adjusting the dosage of diuretic and thiazide diuretic according to the KIM-1 level can enhance the diuretic effect of patients with cardiorenal syndrome and is more conducive to the protection of renal function.