连续性血液净化治疗慢性肾衰竭合并全身炎症反应综合征的临床研究

A clinical research of continous blood purification on treatment of chronic renal failure patients complicated with systemic inflammatory response syndrome

目的观察连续性血液净化(CBP)对慢性肾衰竭(CRF)合并全身性炎症反应综合征(SIRS)患者免疫功能的影响和临床疗效。方法将50例诊断为CRF合并SIRS的患者分为CBP+常规内科治疗组(治疗组)和常规内科治疗组(对照组)两组。观察治疗组在CBP治疗前后免疫功能指标(CD3+、CD4+、CD8+T淋巴细胞百分比)的变化,并比较两组患者治疗前后血白细胞计数(WBC)、中性粒细胞百分比(NEU%)、中性粒细胞计数(NEU)、C反应蛋白(CRP)、尿素氮(Ure-a)、肌酐(Cre)、β2-微球蛋白(β2-MG)等指标的变化;对两组患者的治疗天数和死亡率进行统计学比较。结果治疗组CBP治疗后CD3+、CD4+、CD4+/CD8+较治疗前均显著升高,CD8+较治疗前显著下降;治疗组治疗后各临床指标较治疗前均显著下降,对照组除WBC下降外,其余无显著变化;治疗组较对照组治疗天数缩短,死亡率降低。结论CBP可改善CRF合并SIRS患者的免疫抑制状态,具有较好的临床疗效,与常规内科治疗组比较治疗时间缩短,死亡率降低。

Objective To observe immuneological function and clinical efficacy of chronic renal failure（CRF） patients complicated with systemic inflammatory response syndrome（SIRS）. By the treat-ment of continous blood purification（CBP）. Methods 50 patients who were diagnosed in CRF complicated wth SIRS were divided into two groups. The therapy group was accepted CBP and routine medical treat-ments,the control group was just received medical treatments. The immuneological parameters （CD3^＋, CD4^＋ ,CD8^＋ T leukomonocyte percentage） were observed before and after CBP in the therapy group. The clinical parameters including white blood cell count （ WBC ）, neutrophil persentage （ NEU% ）, neutrophil cell count （ NEU ） , C -reactive protein （CRP） , urea nitrogen （BUN） , creatinine （ Cr ） and 182 -microglobulin （182-MG） ,were compared before and after treatment in each group. The hospital day and mortality were compared between these two groups. Results CD3^＋ , CD4^＋ , CD4^＋/CD8^＋ increased, CD8^＋ decreased significantly after CBP in the therapy group. The clinical parameters decreased significantly in the therapy group, no change was observed in the control group except WBC. Comparing between the two groups, the hospital day of the therapy group was shorter, and mortality was lower. Conclusions CBP is effective and could improve the state of immunosuppression, shorten hospital day and lower mortality in CRF patients complicated with SIRS.