重症急性肾功能衰竭患者连续静—静脉血液透析滤过效果及其对血清炎性因子、免疫功能的影响

The effects of clinical curative effect,inflammatory factors and immune function of continuous venous-venous hemodialysis treatment of patients with acute renal failure

目的观察重症急性肾功能衰竭患者连续静—静脉血液透析滤过效果及其对炎性因子、免疫功能的影响,方法选择2015年4月—2016年3月武汉科技大学附属普仁医院肾内科收治的重症急性肾功能衰竭患者68例为研究对象,采用随机数字表法分为2组各34例,对照组采用传统间歇性血液透析治疗,观察组采用连续静—静脉血液透析滤过治疗,比较2组临床疗效、血清炎性因子、免疫功能、肾功能、不良反应等指标。结果观察组总有效率97.06%明显高于对照组82.35%(χ~2=3.981,P=0.032)。与治疗前比较,2组治疗后血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)含量明显降低,且观察组低于对照组(t=7.813、8.710、5.623,P=0.006、0.002、0.011);2组治疗后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均改善,且观察组CD3^+、CD4^+、CD4^+/CD8^+均明显高于对照组,CD8^+明显低于对照组t=5.525、3.623、2.714、2.346,P=0.013、0.028、0.026、0.033);与治疗前比较,2组治疗后血清血肌酐(SCr)、尿素氮(BUN)含量明显降低,且观察组低于对照组(t=10.697、6.684,P均<0.01)。2组不良反应等比较差异无统计学意义(20.59%vs.17.65%)(χ~2=0.095,P=0.906)。结论连续静—静脉血液透析滤过治疗有助于恢复重症急性肾功能衰竭患者肾功能,提高临床疗效,可能与降低血清炎性因子含量、调节免疫功能等因素有关。

Objective To observe the effect of continuous veno-venous hemodiafiltration on severe acute renal failure and its influence on inflammatory factors and immune function.Methods From April 2015 to March 2016, 68 cases of severe acute renal failure in Puren Hospital were enrolled as the research object, they were randomly divided into 2 groups with 34 cases in each group, the control group used traditional intermittent hemodialysis therapy, the observation group with continuous veno-venous hemofiltration treatment, compared the clinical efficacy of 2 groups, serum inflammatory factor, immune function, renal function, adverse reactions and other indicators were measured and compared.Results The total effective rate of the observation group was significantly higher than that of the control group （97.06% vs.82.35%,χ2=3.981, P =0.032）.Compared with before treatment, the 2 groups after treatment of serum interleukin 6 （IL-6）, IL-8, tumor necrosis factor alpha （TNF-α） content decreased significantly, and the observation group more obviously than the control group （t =7.813, t =8.710, t =5.623, P =0.006, P=0.002, P =0.011）;immune function of 2 groups after treatment were improved.And the observation group CD3＋, CD4^＋ and CD4^＋/CD8^＋ were significantly higher than the control group, CD8^＋ was significantly lower than the control group （t =5.525, t =3.623, t =2.714, t =2.346, P =0.013, P =0.028, P =0.026, P =0.033）;compared with before treatment, the 2 groups after treatment serum creatinine （SCr）, urea nitrogen （BUN） content decreased obviously, and the observation group than the control group （t =10.697, t =6.684, P 〈0.01）.There was no significant difference in adverse reactions between the 2 groups （20.59% vs.17.65%,χ2=0.095, P =0.906）.Conclusion Continuous veno-venous hemofiltration treatment helps restore severe acute renal failure in patients with renal function, improve clinical efficacy, and may reduce the serum inflammatory factor in regulating immune function.