连续性肾脏替代疗法治疗重症急性胰腺炎相关性肾损害及对血清炎性因子水平的影响

The influence of continuous renal replacement treatment on renal damage and inflammatory mediators of patients with severe acute pancreatitis

目的 探讨连续性肾脏替代疗法（CRRT）治疗重症急性胰腺炎患者（SAP）相关性肾损害（AKI）的疗效及其对炎性因子的影响。方法 54例SAP并发AKI患者分别采用常规治疗（对照组）、常规治疗联合CRRT（观察组）,比较两组临床疗效。结果 对照组行机械通气比例显著高于观察组（χ2=4.464,P＜0.05）,两组病死率差异无统计学意义（P＞0.05）。观察组肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平较治疗前均显著降低（均P＜0.01）,脂联素（APN）水平显著升高（P＜0.01）,对照组APN升高,但程度不及观察组,且对照组TNF-α、IL-6水平较治疗前显著升高（均P＜0.01）。观察组治疗后尿量显著增加（P＜0.01）,血尿素氮（BUN）、肌酐（SCr）、APACHEⅡ评分均显著降低（均P＜0.01）,对照组尿量亦有多增加（P＜0.01）,但程度不及观察组,APACHEⅡ评分较治疗前差异无统计学意义（P＞0.05）。对照组BUN、SCr水平增高（均P＜0.05）。结论 CRRT用于SAP合并AKI的救治中,可显著改善患者的肾功能,降低病死率,其机制可能与CRRT可清除机体大量的炎性介质及代谢产物。

Objective To investigate the influence of continuous renal replacement treatment on the therapy of severe acute pancreatitis（SAP） associated with kidney injury（AKI） and inflammatory mediators.Methods Clinical data of 54 SAP patients complicated with AKI,who received conventional treatment（control group） or conventional therapy combined with CRRT（observation group） were retrospectively analyzed.The clinical efficacy between the two groups before and after treatment was compared.Results The mechanical ventilation proportion in control group was significantly higher than in the observation group （χ2=4.464,P〈0.05）.The mortality rate between the two groups had no statistical difference（P〉0.05）.In observation group,TNF-alpha and IL-6 levels were significantly lower than before treatment（P〈0.01）,APN was significantly increased（P〈0.01）.APN also increased in the control group,but the extent was less than the observation group.The levels of TNF-αand IL-6 in the control group were significantly higher than before treatment（P〈0.01）.The urine output of observation group increased significantly after 72h therapy（P〈0.01）.And blood urea nitrogen（BUN）,creatinine（SCr）,APACHE Ⅱ score were significantly decreased（P〈0.01）,in the control group,urine output also increased（P〈0.01）,but the extent was less than the observation group,APACHE Ⅱ score had no significant difference compared with before treatment（P〉0.05）.In control group,BUN and SCr levels significantly increased than before treatment（P〈0.05）.Conclusion CRRT for the treatment of SAP patients complicated with AKI can significantly improve renal function and reduce mortality,and its mechanism may be clear a large number of inflammatory mediators and metabolites in body,reduce the body inflammatory response.