连续性肾脏替代治疗对急性呼吸窘迫综合征患者免疫球蛋白和补体C3表达水平的影响

Effects of continuous renal replacement therapy on the expression of serum immunoglobulins and complement C3 of the patients with acute respiratory distress syndrome

[目的]探讨连续性肾脏替代治疗(CRRT)对急性呼吸窘迫综合征(ARDS)患者血清免疫球蛋白IgA,IgM,IgG和补体C3表达水平的影响.[方法]选择ARDS患者24例,随机分为对照组和CRRT组,每组各为12例.对照组于诊断为ARDS当日即给予机械通气、控制感染、控制液体出入量、激素、利尿剂、保护脏器功能、支持对症等治疗,CRRT组在给予上述常规治疗的基础上联合应用CRRT.利用BNProSpec全自动蛋白分析仪测定两组治疗前(0d)、治疗第3,5d时的血清免疫球蛋白IgA,IgM,IgG和补体C3水平,同时比较两组治疗前后APACHEⅡ评分、机械通气时间及ICU滞留时间.[结果]两组治疗第5d时的APACHEⅡ评分均较同组治疗前明显下降(P<0.05),且CRRT组下降与对照组比较更为明显(P<0.05);与对照组比较,CRRT组ICU滞留时间和机械通气时间均明显缩短(P<0.05).两组血清中IgA,IgG,IgM和补体C3水平随时间变化均呈下降趋势(P<0.05),而CRRT组下降幅度较对照组明显减小(P<0.05).[结论]CRRT通过清除体内炎症介质延缓ARDS患者血清中IgA,IgG,IgM和补体C3水平的下降程度,CRRT可降低ARDS患者APACHEⅡ评分,缩短机械通气时间和ICU滞留时间,对ARDS有治疗作用.

OBJECTIVE To explore the effects of continuous renal replacement therapy（CRRT）on the expression of serum IgA,IgM,IgG and complement C3 of the patients with acute respiratory distress syndrome（ARDS）.METHODS 24 cases of ARDS were selected,and they were randomly divided into control and CRRT group,12 patients in each group.Mechanical ventilation,infection control,fluid intake control,hormones,diuretics,organ function protection and some symptomatic treatments were used for the patients in the control and CRRT group once they were diagnosed with ARDS.At the same time CRRT was used for the patients in the CRRT group.BNProSpec automatic protein analyzer was used to determine the levels of serum immunoglobulin IgA,IgM,IgG and complement C3 of the two groups before treatment and on the 3rd d and 5th d after treatment.The APACHEⅡ scores,mechanical ventilation time,and ICU retention time of the two groups were compared before and after treatment.RESULTS The APACHEⅡscore after 5days of the treatment was significantly decreased as compared with that before the treatment in both groups（P〈0.05）,and the score in the CRRT group decreased more obviously than that in the control group（P〈0.05）.The ICU retention time and the duration of mechanical ventilation were obviously shortened in the CRRP group as compared with those in the control group（P〈0.05）.The levels of serum IgA,IgG,IgM and complement C3 showed the down trend over time in both groups（P〈0.05）,and the levels in the CRRT group decreased less obviously than those in the control group（P〈0.05）.CONCLUSION CRRP could delay the decrease degree of the serum IgA,IgG,IgM and C3 by the clearance of the inflammatory mediators in patients with ARDS.CRRP could decrease the APACHEⅡ score,shorten the duration of mechanical ventilation and the retention time of ICU,it had the therapeutic effects for ARDS.