连续性肾脏替代疗法对重症急性肾功能损伤患者的疗效及IL-6和TNF-α的影响

Effects of continuous renal replacement therapy on clinical effect and IL-6, TNF-α of patients with severe acute kidney injury

目的探讨连续性肾脏替代疗法(CRRT)对重症急性肾功能损伤(AKI)患者的疗效及白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)的影响。方法回顾性分析2015年2月～2016年10月在北京市海淀医院重症医学科采用CRRT进行治疗的55例重症AKI患者的临床资料(研究组),并以同期采用间歇性血液透析(IHD)进行治疗的38例重症AKI患者为对照组。治疗3个月后,分析比较两组临床疗效及IL-6、TNF-α水平。结果治疗后,两组血清肌酐、血尿素氮水平均较治疗前降低,研究组血清肌酐、血尿素氮水平均明显低于对照组,差异有统计学意义(P <0.05)。治疗后,两组血生化指标均较治疗前有明显改善,研究组血生化指标改善情况明显优于对照组,差异有统计学意义(P <0.05)。研究组临床有效率、生存率分别为74.14%、87.27%,均明显高于对照组的57.89%、68.42%,差异均有统计学意义(P <0.05)。治疗后,两组患者IL-6、TNF-α水平均较治疗前明显下降(P <0.05),且研究组IL-6、TNF-α水平明显低于对照组,差异有统计学意义(P <0.05)。结论 CRRT治疗重症急性肾功能损伤患者疗效确切,可有效清除炎性因子,提高患者生存率,值得临床推广。

Objective To investigate the effects of continuous renal replacement therapy(CRRT)on clinical effect and IL-6,TNF-αof patients with severe acute kidney injury(AKI).Methods A retrospective analysis was conducted,including 55 cases with severe AKI treated by CRRT in the Department of Severe Medicine,Beijing Haidian Hospital from February 2015 to October 2016 as study group,and another 38 cases with severe AKI treated by intermittent hemodialysis(IHD)in the same period as control group.After 3 months of treatment,clinical efficacy and interlukin-6(IL-6),umor necrosis factor-alpha(TNF-α)levels of the two groups were analyzed and compared.Results After treatment,the levels of serum creatinine and blood urea nitrogen of the two groups were lower than those before treatment,and the indices in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).After treatment,levels of blood biochemical indices improved in the two groups,the improvement of blood biochemical indices in the study group were better than those in the control group,the differences were statistically significant(P<0.05).The clinical efficacy rate and survival rate in the study group were 74.14%,87.27%respectively,significantly higher than those in the control group(57.89%,68.42%),the differences were statistically significant(P<0.05).After treatment,the levels of IL-6,TNF-αin the two groups were both lower than those before treatment,and the levels of the IL-6 and TNF-αof the study group were significantly lower than those in the control group(P<0.05).Conclusion CRRT can be effective treatment for severe AKI,which can obviously reduce inflammatory factors and efficiently improve survival rate of the patients,and it is worth of clinical promotion.