连续性静-静脉血液滤过联合血液灌流治疗顽固性心衰的疗效研究

Therapeutic Efficacy of Combining Continuous Venovenous Hemofiltration with Hemoperfusion for Refractory Heart Failure

目的:研究连续性静-静脉血液滤过(CVVH)联合血液灌流(HP)能否提高顽固性心衰患者的生存时间。方法:选择2015年3月-2017年1月收住石河子市人民医院的顽固性心衰患者99例,随机分为A组(常规药物治疗)、B组(常规药物+连续性静-静脉血液滤过治疗)、C组(常规药物+连续性静-静脉血液滤过+血液灌流治疗)。测量治疗1月前后肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、超敏C反应蛋白(hs CRP)的含量;随访患者至2017年7月31日,记录患者的生存时间。结果:治疗1月后三组患者的TNF-α、IL-6、IL-8、hs CRP均较治疗前下降(P<0.001),且C组<B组<A组(P<0.05);多因素COX回归分析显示,年龄越大,患者死亡风险越大(HR=1.952,95%CI:1.672~2.279,P<0.001),炎症因子下降数值越大,患者死亡风险越小(HR=0.200,95%CI:0.134~0.299,P<0.001);三组患者生存时间中位数分别为126天、217天、253天,C组与B组差异无统计学意义(P=0.453),C组比A组生存时间长(P<0.001),B组比A组生存时间长(P=0.005);单因素COX回归分析显示,C组的死亡风险是A组的0.326倍(95%CI:0.180~0.591,P<0.001),B组的死亡风险是A组的0.441倍(95%CI:0.232~0.729,P=0.002)。结论:CVVH联合HP治疗顽固性心力衰竭:(1)其清除炎症因子的效果优于CVVH及常规药物治疗;(2)炎症因子水平下降能降低顽固性心衰患者的死亡风险;(3)CVVH+HP提高患者生存时间的效果与CVVH相当,但优于常规药物治疗。

Objective:To investigate the survival time of patients with refractory heart failure by combining continuous venovenous hemofiltration with hemoperfusion therapy.Methods:Ninety-nine patients with refractory heart failure were enrolled from March2015to January2017in Shihezi People’s Hospital,and randomly assigned into conventional treatment group(A group)or conventional treatment combining with continuous venovenous hemofiltration(CVVH)group(B group)or conventional treatment combining with CVVH and hemoperfusion group(C group).Tumor necrosis factor alpha(TNF-α),interleukin6(IL-6),interleukin8(IL-8),and high sensitivity C-reactive protein(hsCRP)were determined before treatment and after treatment for one month.Patients were followed up until July31,2017,and survival time were recorded.Results:After the treatment for one month,the level of TNF-α,IL-6,IL-8,and hsCRP became lower as compared with it before the treatment in all groups(<0.001),and group C was lower than group B(<0.05),and group C was lower than group A(<0.05),and group B was lower than group A(<0.05).Multivariate COX regression analysis showed that,after adjusted by age and estimated glomerular filtration rate,ΔIC decreased the risk of death of patients[HR=0.200,95%CI:0.134~0.299,<0.001].At the end of follow-up period(July31,2017),the median survival time was126days in the group A and217days in the group B and253days in the group C.Kaplan-Meier survival curve and Log-rank test demonstrated that group C and group B were similar(P=0.453),and group C was longer than group A(<0.001),and group B was longer than group A(=0.005).Univariate COX regression analysis showed that,the risk of death in group C was lower than in group A[HR=0.326,95%CI(0.180-0.591),<0.001],and in group B was lower than in group A[HR=0.441,95%CI(0.232-0.729),=0.002].Conclusions:In patients with refractory heart failure,CVVH combining with HP removed more inflammatory cytokines than CVVH or conventional drug therapy.Reducing the levels of inflammation cytokines resulted the risk of death in refractory heart failure.CVVH combining with HP was similar to CVVH improved survival status,but superior to conventional drug therapy,in patients with refractory heart failure.