连续性血液净化联合血液灌流在儿童溶血尿毒综合征中的应用

Application of continuous blood purification combined with hemoperfusion in the treatment of hemolytic-uremic syndrome in children

目的观察连续性血液净化(CBP)联合血液灌流(HP)治疗儿童溶血尿毒综合征(HUS)的疗效并初步探讨其治疗的可能机制。方法在内科治疗基础上,急性期均采用CBP联合HP治疗HUS患儿8例。治疗前后采用化学发光法检测血清IL-6、IL-8、TNF-α水平,并测定血尿素氮(BUN)、肌酐(SCr)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、血红蛋白(Hb)、血小板(PLT)、C反应蛋白(CRP)等水平。8例健康体检儿童作为对照组。结果经CBP联合HP治疗后,8例HUS患儿均存活,病情好转;Hb、PLT水平较治疗前回升,血清IL-6、IL-8、TNF-α、BUN、SCr、ALT、CK、CRP水平较治疗前下降,差异有统计学意义(P<0.05)。结论 CBP联合HP治疗能迅速清除致病因子,又能持续清除炎症介质和毒素,逆转多脏器功能障碍,是治疗儿童HUS的有效方法之一。

Objective To observe the therapeutic effect of continuous blood purification （CBP） combined with hemoperfusion （HP） in children with hemolytic-uremic syndrome （HUS） and to investigate its possible mechanism. Methods Eight children with HUS received CBP combined with HP on the basis of internal medicine treatment in the acute stage. Before and after treatment, serum levels of interleukin-6 （ IL-6）, IL-8 and tumor necrosis factor-a （TNF-a） were measured by chemiluminescence method, and levels of blood urea nitrogen （BUN） , serum creatinine （SCr） , alanine aminotransferase （ ALT）, aspartate aminotransferase （ AST）, creatine kinase （ CK）, creatine kinase MB （ CKMB ）, hemoglobin （Hb）, platelet （PLT） and C-reactive protein （CRP） were measured. Eight healthy children undergoing physical examination were used as controls. Results The 8 children with HUS all survived after CBP combined with FIP and showed improved conditions. They had increased Hb and PLT levels and decreased serum levels of IL-6, IL-8, TNF-a, BUN, SCr, ALT, CK and CRP after treatment （ P 〈 0.05 ）. Conclusions CBP combined with HP can quickly remove pathogenic factors, continually eliminate inflammatory mediators and toxins, and reverse multiple organ dysfunction, and is one of effective methods for treating HUS in children.