连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效及对血清炎症因子的影响

The Effect of Continuous Blood Purification on Patients with Severe Acute Pancreatitisand Acute Kidney Injury and Serum Inflammatory Factors

目的评估连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效及对血清炎症因子的影响。方法回顾性分析我院于2014年11月至2015年11月,治疗的68例重症急性胰腺炎合并急性肾损伤患者的临床资料;其中对照组34例,采取一般常规治疗;观察组34例,在一般常规治疗的基础上,联合连续性血液净化治疗;对比两组患者治疗前后的肾功能改善情况、血清炎症因子消除情况,根据急性生理与慢性健康评分表评分(APACHEⅡ评分),综合评价患者的临床疗效,并作对比分析。结果治疗前,两组患者血尿素氮(BUN)、血肌酐(SCr)水平均无显著性差异(P>0.05);治疗后,观察组患者BUN、SCr水平降低幅度显著大于对照组,具有显著性差异(P<0.05);治疗前,两组患者血清白细胞介素-6、10(IL-6、10)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均无显著性差异(P>0.05);治疗后,观察组患者血清IL-6、IL—10、TNF-α、CRP水平均显著低于治疗前水平(P<0.05),且与对照组对比,具有显著性差异(P<0.05);治疗前,两组患者APACHEⅡ评分无显著性差异(P>0.05);治疗后,观察组患者APACHEⅡ评分均显著低于治疗前,且与对照组对比,具有显著性差异(P<0.05)。结论连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效确切,可保护肾功能,消除血清炎症因子,抑制病情发展及改善预后,临床应用前景广阔。

Objective To evaluate curative effect of the continuous blood purification for treatment of acute kidney injury in severe acute pancreatitis and the influence on serum inflammatory factors. Methods A retrospective analysis from November 2014 to November 2015 included 68 cases of severe acute pancreatitis who also had acute kidney injury; Among them 34 cases treated with conventional as control group; Observation group of 34 cases received conventional therapy, plus continuous blood purification therapy. Renal function before and after treatment were compared between two groups. Serum inflammatory factor change, the acute physiology and chronic health evaluation score （APACHE II） and comprehensive evaluation of the patient＇s clinical curative effect were all included in the comparative analysis . Results Before treatment, blood urea nitrogen （BUN）, serum creatinine （SCr） levels were not significantly different （P〉0.05） between groups; after treatment, BUN, SCr in the observation group were significantly higher than that in the control group （P〈0.05）. Before the treatment, two groups of patients＇ serum interleukin-6 （IL-6）,interleukin 10 （IL-10）, tumor necrosis factor alpha （TNF-α）, c-reactive protein （CRP） in the observation group had no significant difference （P〉0.05）; After treatment, IL-6, IL-10, the TNF-α and CRP levels were significantly lower than that before treatment （P〈0.05）; and whencompared with the control group, the difference was significant （P〈0.05）. Before the treatment, APACHE II score had no statistical difference between groups （P〉0.05）; after treatment, APACHE II score in the observation group was significantly lower than before treatment; when compared with the control group, the difference was significant （P〈0.05）. Conclusion Continuous blood purification applied in the treatment of severe acute pancreatitis complicated with acute kidney injury showed promising curative effect. The combined therapy can protect renal function, eliminate inflammatory factors, slow down its progression and improve patient’s prognosis.