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探讨“AKIN”标准及病理诊断指导下实施体外循环免疫净化(ECIP)救治妊娠期并发急性肾衰竭(ARF)对预后的影响。(1)观察ECIP干预时机对肾功能延迟恢复发生率、病死率的影响。根据“AKIN”标准分为两组:A组14例(37.84%)在AKI损伤期实施ECIP;B组23例(62.16%)在AKI衰竭期实施ECIP。(2)观察ECIP治疗前后,急性生理功能和慢性健康状况评分系统II(APACHEII)评分值、血肌酐(Scr)、尿酸(UA)、半胱氨酸蛋白酶抑制蛋白C(CysC)、乳酸脱氢酶(LDH)等动态变化。对7例肾功能延迟患者实施经皮肾穿刺活检术,观察其病理类型变化。结果表明:(1)产后患者出现少尿,血CysC、UA水平和APACHEII评分值明显增高,在48 h达高峰;而Scr浓度于产后48 h增高,在产后72 h达高峰;经ECIP治疗后,患者血CysC、UA、Scr、LDH水平和APACHEⅡ值明显降低。经相关分析发现,患者血UA水平与血清CysC含量变化呈现正相关(r=0.61,P<0.05)。(2)肾功能恢复率(Scr回到基线水平):A组明显高于B组(P<0.05)。(3)33例(89.19%)肾功能得以恢复。B组患者死亡2例(5.41%),死亡原因为严重感染、多脏器功能不全;肾脏死亡2例,需依赖透析维持生命(5.41%)。(4)肾功能延迟恢复者的肾脏病理主要类型为:溶血性尿毒综合征、新月体肾炎、毛细血管内增生性肾炎及血管炎。妊娠AKI是一种特殊类型的系统性疾病,肾小球固有细胞的损伤是导致此类患者人/肾死亡的重要原因。半胱氨酸蛋白酶抑制蛋白C(CysC)能敏感、精确地反映肾小球滤过率变化(GFR)。根据AKIN分层诊断标准,选择“适宜”的ECIP时机调整免疫功能,能保护肾固有细胞,改善预后。
To investigate the effect of extracorporeal circulation immune clearance (ECIP) on the prognosis of pregnancy-induced acute renal failure (ARF) under the guidance of “AKIN” standard and pathological diagnosis. (1) To observe the impact of ECIP intervention timing on the delayed recovery of renal function and mortality. According to the criteria of “AKIN”, the patients were divided into two groups: 14 cases (37.84%) in group A were treated with ECIP in AKI injury stage and 23 cases (62.16%) in group B were treated with ECIP in AKI failure stage. (2) Before and after ECIP treatment, acute physiology and chronic health assessment score II (APACHEII) score, serum creatinine (Scr), uric acid (UA), cystatin C (CysC), lactate dehydrogenation Enzyme (LDH) and other dynamic changes. Percutaneous renal biopsy was performed on 7 patients with delayed renal function and their pathological changes were observed. The results showed that: (1) oliguria was found in postpartum patients, blood CysC, UA level and APACHEII score were significantly increased and peaked at 48 h; while Scr concentration increased at 48 h postpartum and peaked at 72 h postpartum; after ECIP treatment , The levels of CysC, UA, Scr, LDH and APACHEⅡwere significantly decreased in the patients. Correlation analysis showed that there was a positive correlation between serum UA level and serum CysC level (r = 0.61, P <0.05). (2) Renal function recovery rate (Scr back to baseline): A group was significantly higher than B group (P <0.05). (3) 33 cases (89.19%) of renal function recovered. Two patients died in group B (5.41%). The cause of death was severe infection and multiple organ dysfunction. Two patients died of renal failure and needed to rely on dialysis to maintain their life (5.41%). (4) Renal pathological changes were mainly delayed kidney function were: hemolytic uremic syndrome, crescentic glomerulonephritis, capillary proliferative glomerulonephritis and vasculitis. AKI is a special type of systemic disease during pregnancy, and damage to glomerular innate cells is a major cause of human / kidney death in such patients. Caspase C (CysC) is sensitive and accurately reflects glomerular filtration rate changes (GFR). According to AKIN stratified diagnostic criteria, select the “appropriate” ECIP timing to adjust immune function, can protect renal cells, improve the prognosis.