【摘要】 目的探讨血清肾损伤分子1（KIM-1）和IL-18与老年ICU患者肾功能以及预后的关系。方法老年ICU患者42例,根据内生肌酐清除率（Ccr）分为A1组(<60 ml·m^-2·min^-1,25例)和A2组(≥60 ml·m^-2·min^-1,17例);根据急性生理学及慢性健康状况Ⅱ（APACHEⅡ）评分分为B1组（<15分,10例）、B2组（15～24分,19例）和B3组（≥25分,13例）;根据多器官功能障碍综合征（MODS）评分分为C1组（<5分,19例）、C2组（5～10分,16例）和C3组（≥11分,7例）。随访28 d,根据存活情况将患者分为存活组（24例）及死亡组（18例）。比较各组血清KIM-1和IL-18水平以及肾功能等指标。结果 A2组血清尿素氮、肌酐和IL-18水平及APACHEⅡ评分、MODS评分、MODS发生及死亡比例均低于A1组（P<0.05）。血清IL-18水平与Ccr呈负相关（r=-0.642,P<0.01）。B2组和B3组MODS评分、MODS发生及死亡比例均较B1组高（P<0.05）,B3组血清尿素氮、肌酐、KIM-1、IL-18水平较B1组和B2组高（P<0.05）。C2组和C3组血清IL-18水平及APACHEⅡ评分、死亡比例高于C1组（P<0.05）,C3组血清尿素氮、肌酐、KIM-1水平及MODS发生比例高于C1组（P<0.05）。死亡组血清KIM-1、IL-18、肌酐水平及APACHEⅡ评分、MODS评分均高于存活组,而Ccr低于存活组（P<0.05）。结论老年ICU患者血清IL-18水平更能反映患者肾功能,并可能与患者预后有关。更多还原

【Abstract】 Objective To investigate the relationship of serum kidney injury molecule 1（KIM-1） and IL-18 levels and renal function and prognosis of elderly patients in ICU.Methods According to creatinine clearance rate（Ccr）,42 elderly patients with severe illness in ICU were divided into groups of A1(<60 ml·m^-2·min^-1,25 cases) and A2(≥60 ml·m^-2·min^-1,17 cases).According to acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score,the patients were divided into groups of B1（<15 points,10 cases）,B2（15-24 points,19 cases） and B3（≥25 points,13 cases）.According to multiple organ dysfunction syndrome（MODS） score,the patients were divided into groups of C1（<5 points,19 cases）,C2（5-10 points,16 cases） and C3（≥11 points,7 cases）.The patients were followed up for 28 days,during which 24 cases were survival（group D1） and 18 cases were dead（group D2）.Serum KIM-1 and IL-18 levels and renal function were compared.ResultsSerum levels of IL-18,usea nitrogen and creatinine and APACHEⅡ score,MODS score,proportions of MODS and death cases were lower in group A2 than those in group A1（P<0.05）.Serum IL-18 level was negatively correlated to Ccr（r=-0.642,P<0.01）.MODS score,proportions of MODS and death cases were higher in groups of B2 and B3 than those in group B1（P<0.05）.Serum levels of KIM-1,IL-18,usea nitrogen and creatinine were higher in group B3 than those in groups of B1 and B2（P<0.05）.Serum IL-18 level and APACHEⅡ score and proportion of death cases were higher in groups of C2 and C3 than those in group C1（P<0.05）.Serum levels of KIM-1,usea nitrogen and creatinine and proportion of death cases of MODS were higher in group C3 than those in group C1（P<0.05）.Serum levels of KIM-1,IL-18 and creatinine and APACHEⅡ score and MODS score were higher and Ccr was lower in group D2 than those in group D1（P<0.05）.Conclusion Serum levels of IL-18 can better reflect the renal function of elderly patients in ICU,which may be related to the prognosis.更多还原