血液灌流治疗对脓毒症急性肾损伤患者炎症因子的清除及肾脏保护作用

Removal of inflammatory cytokines by hemoperfusion for protecting the kidney from acute injury in patients with sepsis

目的 探讨血液灌流（hemoperfusion,HP）治疗对重症脓毒症急性肾损伤（acute lung injury,AKI）患者体内炎症因子的清除及对肾功能的保护作用.方法 本研究为前瞻、对照研究,选取40例2007年至2009年广州市第一人民医院ICU住院脓毒症及急性肾损伤患者进行随机分组.其中22例接受血液灌流治疗,每次2 h,连续3 d,采用珠海丽珠公司HA330型大孔径中性树脂灌流器;18例仅接受常规治疗.所有患者均于治疗前,治疗3 d,7 d及14 d分别抽血检测IL-6,IL-10的水平,及C反应蛋白水平,并记录24 h尿量,Scr及相关肾小管功能指标.结果 与对照组相比,HP治疗组患者治疗后血浆CRP及IL-6IL-10水平明显下降（P＜0.05）,同时尿量显著增加,尿N,乙酰-B-氨基葡萄糖苷酶（NAG）,γ-GTP,α1-微球蛋白及血BUN,Scr水平均明显低于对照组（P＜0.05）.此外,AKI患者Ⅰ、Ⅱ期接受血液灌流治疗的患者肾功能恢复率及生存率均高于对照组（P＜0.05）.两组患者治疗前后血流动力学改变,如平均动脉压水平差异均无统计学意义（P＞0.05）.结论 血液灌流早期治疗脓毒症急性肾损伤患者可能通过有效清除炎症因子起到保护肾小管及促进肾功能恢复的作用.

Objective To study the protective effect of removing inflammatory cytokines by hemoperfusion （HP）on acute kidney injury （AKI） in patients with sepsis. Method A total of 40 patients with sepsis and AKI were randomly divided into two croups： HP treatment group （n = 22） and control group （n = 18）. Hemoperfusion carried out in patients of Hp group with HA330 filter once a day for 3 days and the procedure of each hemoperfusion was completed in 2 hours. The patients of control group were treated with routine treatment. Further, the hemodynamics, plasma IL-6, IL-10, C-reactive protein （CRP）, serum creatinine （Scr）, blood BUN and urine NAG, γ-GTP,α1-MG of patients in both groups were detected before treatment and 3 d,7 d and 14 days after treatment. Results Compared to control group, the levels of plasma interleukins-6, IL-10 and C-reactive protein were significantly lower （P 〈 0.05）, along with increase in urine output, lower levels of blood BUN and Scr, reduction in urine NAG,γ-GT and α1-MG （P 〈 0.05）. In addition, the patients at Ⅰ or Ⅱ stage of AKI treated with hemoperfusion had significantly lower level of Scr in 14 days and lower mortality in intensive care unit in comparison with control group （P 〈 0.05）. Conclusions Hemoperfusion employed in the earlier stage of AKI with the HA type filter may have protective effect on acute kidney injury by the removal of inflammatory cytokines in the setting of sepsis.