连续性肾脏替代治疗在脓毒症合并急性肾损伤中的研究进展

doi:10.3969/j.issn.1004-583X.2026.04.014

摘要/Abstract

摘要：

脓毒症是由于感染所致全身炎症反应综合征,可导致急性肾损伤和多脏器功能障碍,严重者可危及生命。连续性肾脏替代治疗是一种连续、缓慢清除水分和溶质,且对脏器起支持作用的技术,已成为针对急性肾损伤的重症患者,尤其是血液动力学不稳定患者的首选透析模式。本文就连续性肾脏替代治疗在脓毒症合并急性肾损伤中的研究进展进行综述,旨在为临床治疗决策和后续研究提供参考。

关键词: 急性肾损伤, 脓毒症, 连续性肾脏替代治疗, 炎症介质, 生物标志物, 预后

中图分类号:

R692.5

刘一坤, 张明, 刘倩, 孙绍婷, 李媛媛, 杜书同. 连续性肾脏替代治疗在脓毒症合并急性肾损伤中的研究进展[J]. 临床荟萃, 2026, 41(4): 374-379.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.04.014

https://www.lchc.cn/CN/Y2026/V41/I4/374

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参考文献 45

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生物标记物	诊断AKI价值	优势场景
IGFBP-7	敏感度高,升高时间窗极早	识别早期亚临床肾损伤
TIMP-2	联合IGFBP-7,提高AKI诊断准确性	AKI早期预警
NGAL	与AKI严重程度正相关	AKI早期预警
KIM-1	对肾小管损伤特异性高	鉴别缺血性/中毒性肾小管损伤
PENK	与AKI严重程度正相关	预后预测价值
IL-18	对肾小管损伤特异性高	提高脓毒症AKI诊断准确性
神经轴突导向因子-1	对肾小管损伤特异性高	预后预测价值

生物标记物	诊断AKI价值	优势场景
IGFBP-7	敏感度高,升高时间窗极早	识别早期亚临床肾损伤
TIMP-2	联合IGFBP-7,提高AKI诊断准确性	AKI早期预警
NGAL	与AKI严重程度正相关	AKI早期预警
KIM-1	对肾小管损伤特异性高	鉴别缺血性/中毒性肾小管损伤
PENK	与AKI严重程度正相关	预后预测价值
IL-18	对肾小管损伤特异性高	提高脓毒症AKI诊断准确性
神经轴突导向因子-1	对肾小管损伤特异性高	预后预测价值

指标	CRRT	IHD	优势倾向
血流动力学稳定性	血流动力学平稳,耐受性好	快速超滤,易发生低血压	CRRT
对脏器功能保护	利于保护心、脑、肾等脏器	脏器保护作用较弱	CRRT
医护与资源需求	人力、耗材及费用较高	操作简便,资源消耗较低	IHD
并发症发生率	相对安全,不良事件发生率低	不良心血管事件发生率较高	CRRT
脓毒症合并AKI病死率	预后好,病死率低	安全性差,病死率高	CRRT

指标	CRRT	IHD	优势倾向
血流动力学稳定性	血流动力学平稳,耐受性好	快速超滤,易发生低血压	CRRT
对脏器功能保护	利于保护心、脑、肾等脏器	脏器保护作用较弱	CRRT
医护与资源需求	人力、耗材及费用较高	操作简便,资源消耗较低	IHD
并发症发生率	相对安全,不良事件发生率低	不良心血管事件发生率较高	CRRT
脓毒症合并AKI病死率	预后好,病死率低	安全性差,病死率高	CRRT

连续性肾脏替代治疗在脓毒症合并急性肾损伤中的研究进展

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