CRRT在肾移植术后巨细胞病毒性肺炎治疗中的应用

Effects of continuous renal replacement therapy on the treatment of cytomegalovirus pneumonia following kidney transplantation

目的探讨连续肾脏替代治疗(CRRT)在治疗肾移植术后巨细胞病毒(CMV)肺炎的疗效。方法2003年1月至2007年12月期间,肾移植术后CMV肺炎30例,分为CRRT组(n=15)和对照组(n=15),对照组给予常规治疗,CRRT组在常规治疗基础上加用CRRT治疗,采用BM25连续血液净化系统,AN69膜血滤器进行前稀释连续静脉-静脉血液滤过(CVVH)。检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平,比较两组呼吸机使用时间、住院时间和病死率。结果发病时(0d)两组血清TNF-α、IL-8水平较发病前显著升高(均P<0.01),对照组在治疗7d后TNF-α、IL-8水平继续升高,14d后开始下降,而CRRT组TNF-α、IL-8水平较对照组显著降低(均P<0.05)。CRRT组呼吸机使用时间(7.2±2.5)d明显较对照组(9.8±3.0)d缩短(P<0.01),住院时间(21.2±5.3)d也明显较对照组(26.1±5.5)d缩短(P<0.01);CRRT组和对照组分别有3例(3/15)和5例(5/15)患者死亡,病死率比较无统计学差异(P>0.05)。结论CRRT在治疗肾移植术后CMV肺炎时可有效清除炎症介质,提高救治CMV肺炎的疗效。

Objective To observe the efficacy of continuous renal replacement therapy （CRRT） on cytomegalovirus （CMV） pneumonia following kidney transplantation. Methods Thirty recipients of kidney transplantation complicated with CMV pneumonia during the period of January 2003 to December 2007 were randomly divided into CRRT group （n=15） and control group （n=15）. Patients in control group were treated with the routine conservative therapy, and those in CRRT group were treated with CRRT besides the routine conservative therapy. BM25 continuous blood purification system and AN69 hemofilter were used to perform the pre-dilution continuous venous-venous hemofiltration. Serum TNF-a and IL-8 were measured. Duration of mechanical ventilation, average hospitalized day and mortality rate were observed. Results Serum TNF-a and IL-8 were significantly increased on admission day （day 0） in the two groups compared with the values before the infection （P〈 0.01, for both groups）. On the 7th day after treatment, serum TNF-a and IL-8 in control group remained increased, and then decreased after the 14th day as the patients recovered. In CRRT group, serum TNF-a and IL-8 levels were significantly lower than those in control group （P〈 0.05, for serum TNF-a and IL-8）. The duration of mechanical ventilation was shorter in CRRT group （7.2 ± 2.5 days） than in control group （9.8 ± 3.0 days, P〈 0.01）, and the average hospitalized day was also shorter in CRRT group （21.2 ± 5.3 days） than in control group （26.1 ± 5.5 days, P 〈 0.01）. There was no statistical difference in mortality rate between the two groups （P〉 0.05）. Conclusion CRRT has a therapeutic effect on CMV pneumonia following kidney transplantation by clearance of systemic inflammatory factors.