血液灌流对急性肾衰竭患者微炎症状态的影响

The influnence of hemoperfusion on microinflammatory state in acute renal failure patients

目的观察急性肾衰竭(ARF)患者体内炎症因子的表达情况及血液灌流对其的清除效果。方法选择山西医科大学第二医院肾内科确诊的肾性单纯型ARF患者76例,随机分为两组:血液灌流联合血液透析组(HP+HD组)和单纯血液透析组(HD组),每组各38例,分别于治疗前、后采血;健康人25例作为对照组;ELISA方法检测血中C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)水平。结果透析及灌流治疗前两组患者血CRP、IL-6、TNF-α水平均高于正常对照组(P<0.001),两组之间各因子水平差异无显著性(P>0.05);透析及灌流治疗前3组各因子相互之间呈显著正相关(P<0.001);透析及灌流治疗后各因子水平较治疗前降低,其中(HP+HD)组差异有统计学意义(P<0.001),HD组差异无统计学意义(P>0.05)。结论ARF患者可能存在类似慢性肾衰竭(CRF)的微炎症状态,血液灌流是其有效的治疗手段。

Objective To observe levels of serum inflammatory factors and effect of hemoperfusion （HP） on acute renal failure（ARF） patients. Methods Seventy-six patients with simple ARF（without acute or chronic infection, malignancy, multiple organ failure, glucocorticold and immunosuppressant treatment, history of blood transfusion）were randomly divided into hemoperfusion combined with hemodialysis （HD） group （HP＋HD group, n=38） normal control group consisted of 25 healthy people. The serum CRP, IL-6 and TNF α levels of all patients and controls were detected by ELISA before and after the treatments. Results The serum CRP, IL- 6 and TNF α levels in both treatment groups were significantly higher than those in control group（P〈0.001）, and there were no significant difference between two treated groups before treatment （P〉0. 05）. The levels of CRP, IL-6 and TNF α had significant positive correlation in all groups（P〈0.001）; The serum CRP, IL-6 and TNF α levels decreased after treatment, and there was significant difference in HP＋HD group （P〈0.001）, but not in HD group （P〉0. 05）. Conclusion There are high levels of microinflammatory factors such as CRP, IL-6 and TNF α in ARF patients, which may be the evidence of microinflammatory state in ARF patients as CRF patients. The study also suggests that HP is an effective method to remove increased inflammatory factors in ARF patients.