急性肾衰发病
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急性肾衰竭发病机制
急性肾衰竭发病机制
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肾缺血<!--EndFragment-->
肾灌注压降低
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">失血、脱水、休克、心力衰竭等均可造成有效循环血量减少，动脉血压降低</span><!--EndFragment--><br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">血压降至</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:<br>minor-fareast;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:text1;mso-ansi-language:<br>EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">10.7kPa</span><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">（</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:<br>minor-fareast;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:text1;mso-ansi-language:<br>EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">80mmHg</span><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">）以下时，肾血流量失去自身调节，肾血管平滑肌收缩，阻力增加，肾血流量和</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">GFR</span><span style="font-size:12.0pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">降低。</span><!--EndFragment--> <br>
肾血管收缩
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">体内儿茶酚胺增加</span><!--EndFragment-->
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">休克、创伤或肾中毒</span><!--EndFragment--> 引起交感-肾上腺髓质系统兴奋 <br>
入球小动脉敏感 肾<!--[if gte mso 9]><xml>
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<![endif]--><!--StartFragment--><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:
Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;
mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:
"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;
mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">皮质外层血流量减少最为明显</span><!--EndFragment-->
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">肾素</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">-</span><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">血管紧张素系统激活</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">入球小动脉管壁张力下降，刺激球旁细胞分泌肾素</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">近曲小管及髓袢升支粗段受损</span><!--EndFragment--> ，对钠重吸收减弱<br><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">远曲小管尿液中的</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;mso-ascii-theme-font:<br>minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">Na<sup>+</sup></span><span style="font-size:<br>12.0pt;font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">浓度升高，刺激<span style="background:yellow;mso-highlight:yellow">致密斑分泌肾素</span></span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">激肽和前列腺素生成减少</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">肾髓质间质细胞合成扩血管的激肽和前列腺素</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;mso-ascii-theme-font:<br>minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">E<sub>2</sub></span><span style="font-size:12.0pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">减少</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">缩血管的血栓素</span><span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;mso-ascii-theme-font:<br>minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">A<sub>2</sub></span><span style="font-size:12.0pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">相对增加，导致肾血管收缩</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">肾血液流变学的变化</span><!--EndFragment--> <br>
血液粘滞度上升
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">血中<span style="color:black;<br>mso-themecolor:text1">纤维蛋白原增多</span></span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">红细胞变形能力下降，聚集、破裂、血红蛋白释出</span> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">血小板聚集</span><!--EndFragment--> <br>
白细胞作用
白细胞变形能力降低，粘附于血管壁
微血管改变
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">血管内皮细胞肿胀使肾微血管口径缩小</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">白细胞附着于微血管壁</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾微血管自动调节功能丧失</span><!--EndFragment--> <br>
肾小管阻塞
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾缺血以及肾中毒引起的</span><span lang="EN-US" style="font-size:12.0pt;font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:<br>minor-fareast;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:text1;mso-ansi-language:<br>EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">ATN：</span><span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">脱落的上皮细胞及碎片</span> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">异型输血、挤压综合征等引起的</span><span lang="EN-US" style="font-size:12.0pt;<br>font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">ATN：</span><span style="font-size:12.0pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">血红蛋白或肌红蛋白等形成的管型</span> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">其他：多发性骨髓瘤本周蛋白、磺胺等药物结晶、尿酸盐结晶</span><!--EndFragment--> <br>
原尿反流
<span lang="EN-US" style="font-size:12.0pt;font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:<br>minor-fareast;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:text1;mso-ansi-language:<br>EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">ATN：</span> <span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾小管上皮细胞广泛坏死，基膜断裂，尿液经断裂的基膜扩散到肾间质</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾间质水肿</span><!--EndFragment--> ：<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾小管受压，阻塞加重</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">肾间质水肿</span><!--EndFragment--> ：<span style="font-size:12.0pt;font-family:宋体;mso-ascii-font-family:<br>Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">毛细血管受压，肾小管供血进一步减少</span><!--EndFragment--> <br>
细胞受损
肾小管细胞
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">小管破裂性损伤</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">肾小管上皮细胞坏死、脱落，基底膜破坏</span> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">肾小管各段都可受累</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">肾毒性损伤</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">肾小管上皮细胞大片坏死，但基底膜完整</span><!--EndFragment--><br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">主要涉及近曲小管</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">大多数急性肾衰竭病例以肾小管细胞功能紊乱为主，而非坏死</span><!--EndFragment--><br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">内皮细胞</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">激发血小板聚集、微血栓形成以及毛细血管内凝血</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">内皮细胞窗孔变小、甚至减少，可直接影响超滤系数</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">放舒血管因子减少、缩血管因子增多，造成肾血管持续收缩</span><br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">肾系膜细胞</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">机体释放的血管紧张素和</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:10.5pt;font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-font-family:宋体;mso-fareast-theme-font:<br>minor-fareast;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman";<br>mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">ADH</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;mso-ansi-language:EN-US;<br>mso-fareast-language:ZH-CN;mso-bidi-language:AR-SA">等体液因<span style="color:<br>black;mso-themecolor:text1">子</span></span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">外源性毒物</span><span lang="EN-US" style="font-size:<br>12.0pt;mso-bidi-font-size:10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">(</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">如庆大霉素、硝酸铀等</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:<br>10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">)</span><!--EndFragment--> <br>
<span lang="EN-US" style="text-indent: -36pt; color: black;"><span style="font-size: 7pt; line-height: normal; font-family: 'Times New Roman';"> </span></span><span style="text-indent: -36pt; font-size: 12pt; font-family: 宋体; color: black;">细胞损伤</span><br><!--EndFragment-->
<span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:<br>10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">ATP</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">产生减少及</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:<br>10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">ATP</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">酶活性降低</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">自由基产生增多与清除减少</span><!--EndFragment--><br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">磷脂酶活性增高</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">细胞内</span><span lang="EN-US" style="font-size:<br>12.0pt;mso-bidi-font-size:10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-font-family:宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">Ca2+</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">浓度升高和还原型</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:<br>10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">GSH</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">减少时，磷脂酶</span><span lang="EN-US" style="font-size:12.0pt;mso-bidi-font-size:<br>10.5pt;font-family:Calibri;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:<br>宋体;mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:minor-latin;<br>mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">A2</span><span style="font-size:12.0pt;<br>mso-bidi-font-size:10.5pt;font-family:宋体;mso-ascii-font-family:Calibri;<br>mso-ascii-theme-font:minor-latin;mso-fareast-theme-font:minor-fareast;<br>mso-hansi-font-family:Calibri;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:<br>"Times New Roman";mso-bidi-theme-font:minor-bidi;color:black;mso-themecolor:<br>text1;mso-ansi-language:EN-US;mso-fareast-language:ZH-CN;mso-bidi-language:<br>AR-SA">活性增强，分解膜磷脂</span><!--EndFragment--> <br>
<span style="font-size:12.0pt;mso-bidi-font-size:10.5pt;<br>font-family:宋体;mso-ascii-font-family:Calibri;mso-ascii-theme-font:minor-latin;<br>mso-fareast-theme-font:minor-fareast;mso-hansi-font-family:Calibri;mso-hansi-theme-font:<br>minor-latin;mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi;<br>color:black;mso-themecolor:text1;mso-ansi-language:EN-US;mso-fareast-language:<br>ZH-CN;mso-bidi-language:AR-SA">细胞骨架结构改变</span><!--EndFragment--> <br>
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