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目的探讨肝硬化初发急性肾损伤(acute kidney injury,AKI)患者的AKI分期与补液扩容为主的综合治疗的疗效关系,探讨AKI分期与尿肾损伤分子-1(kidney injury molecule-1,KIM-1)水平的关系。方法 2014年9月至2017年1月收治肝硬化合并新发AKI患者61例,分为AKI 1期及2~3期,停用利尿剂、血管扩张剂及肾毒性药物,给予补液扩容为主的综合治疗48 h,评价初发AKI时、治疗48 h两个时间点的疗效;采用ELISA方法检测尿KIM-1,分析AKI分期与疗效、尿KIM-1的关系。结果 61例肝硬化初发AKI患者,AKI 1期47例,2~3期14例;治疗48 h后,AKI 1期治疗有效率高于AKI 2~3期(63.8%vs.28.6%,P<0.05);相同AKI分期患者治疗48 h前后血BUN、SCr和尿KIM-1的差异均有统计学意义(P<0.05)。AKI 1期患者对扩容治疗的疗效优于2~3期。AKI 1期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.310,P=0.766);AKI 2~3期患者扩容治疗前后,尿KIM-1水平的差异无统计学意义(Z=-0.392,P=0.696)。结论肝硬化初发AKI患者的分期越高,尿KIM-1水平越高;扩容治疗无效组尿KIM-1水平高于有效组。
Objective To investigate the curative effect of AKI staging combined with rehydration expansion in the treatment of acute kidney injury (AKI) in cirrhotic patients and explore the relationship between AKI staging and urinary renal injury molecule-1 (KIM) -1) level of the relationship. Methods From September 2014 to January 2017, 61 patients with cirrhosis complicated with newly diagnosed AKI were divided into two groups: AKI stage 1 and 2 to 3, diuretics, vasodilators and nephrotoxic drugs were discontinued. For 48 h. The curative effect was evaluated at two time points of 48 h after initial AKI. Urinary KIM-1 was detected by ELISA, and the relationship between AKI staging and urinary KIM-1 was analyzed. Results Among the 61 patients with AKI with initial cirrhosis, 47 patients were AKI stage 1 and 14 patients were treated with stage 2 to 3. The effective rate of AKI stage 1 treatment was higher than that of AKI stage 2 to stage 48 h after treatment for 48 h (63.8% vs.28.6%, P <0.05). There were significant differences in serum BUN, SCr and urinary KIM-1 between the same AKI stage and the 48th hour after treatment (P <0.05). AKI 1 patients with the effect of dilatation and treatment is better than 2 to 3. There was no significant difference in urinary KIM-1 level before and after AKI stage 1 expansion (Z = -0.310, P = 0.766). There was no significant difference in urinary KIM-1 levels between the two stages before AKI in patients with AKI Significance (Z = -0.392, P = 0.696). Conclusions The higher the stage of AKI in cirrhotic patients, the higher the level of KIM-1 in urine. The level of urinary KIM-1 in patients with cirrhosis-refractory AKI is higher than the effective group.