脓毒症急性肾损伤早期预警指标研究进展.docVIP

脓毒症急性肾损伤早期预警指标研究进展 　　[摘要] 随着医疗技术的发展，脓毒症作为一种危重病，其发病机制及发病特征逐渐被人们认识。在积极抗炎治疗的同时，预防各种并发症的发生对降低脓毒症患者病死率及改善预后意义重大。其中急性肾损伤（AKI）是脓毒症常见的严重并发症。如不能够早期诊断，及时采取保护措施，肾功能将可能急剧恶化，使肾替代治疗使用率明显上升，进而显著增加住院时间、医疗费用以及病死率。近年来动物实验及临床研究发现，有多种生物标志物在AKI早期诊断方面较血肌酐、尿量变化等传统指标存在优势，表现出更高的敏感性和特异性。本研究通过对肾小球、肾小管损伤以及其他与脓毒症AKI诊断相关的生物标志物进行综述，为脓毒症AKI的早期预警提供方向。 　　[关键词] 脓毒症；急性肾损伤；生物标志物；早期预警 　　[中图分类号] R631 [文献标识码] A [文章编号] 1673-7210（2017）01（a）-0044-04 　　[Abstract] With the development of medical technology， sepsis as a kind of critical illness， which pathogenesis and characteristics are gradually recognized. At the same time of active anti inflammation treatment， prevention of various complications is significant to reduce mortality and improve the prognosis of patients with sepsis. Acute kidney injury （AKI） is a common and severe complication of sepsis. If it could not be diagnosed as early as possible and take protective measures in time， renal function will be dramatically worse， the use of renal replacement therapy will be significantly increased， and the length of hospital stay， medical expenses and mortality will be significantly increased. In recent years， animal experiment and clinical study find that a variety of biomarkers have advantages than traditional indicators such as serum creatinine， urine volume changes in the early diagnosis of AKI， showing higher sensitivity and specificity. In this study， we review the biological markers related to the diagnosis of AKI in patients with glomerular and tubular injury， as well as other biomarkers， to provide direction for early warning of sepsis AKI. 　　[Key words] Sepsis； Acute kidney injury； Biomarker； Early warning 　　脓毒症（Sepsis）是急诊科重症监护室常见的危重病，病死率一直偏高，当并发急性肾损伤（acute kidney injury，AKI）后，预后更差，病死率明显高于脓毒症非AKI患者。早期判断脓毒症AKI的发生，尽早采取有效的、针对性的措施，有利于改善脓毒症患者预后，降低病死率[1]。传统的肌酐、尿量监测由于其滞后性，无法足够敏感地对脓毒症AKI的发生进行早期预警。随着对脓毒症所致AKI病理生理机制及蛋白组学的深入研究，一些潜在的生物学标志物不断被发现。这些生物标志物在血液及尿液中表达和积累，升高时间早于血肌酐和尿量的变化，理论上可用于AKI早期诊断，预警脓毒症AKI的发生。 　　1 脓毒症AKI发病机制及诊断现状 　　脓毒症所致AKI的机制尚不完全清楚，但相关实