高剂量连续静脉血液透析对脓毒血症所致急性肾衰竭患者炎症及免疫功能的影响

Effects of High-dose Continuous Venous Hemodialysis on Inflammatory and Immune Function in Patients with Sepsis-induced Acute Renal Failure

目的探讨高剂量连续静脉血液透析对脓毒血症所致急性肾衰竭患者炎症及免疫功能的影响,为患者的临床诊疗提供指导。方法回顾性分析2016年1月-2019年1月上海市第一人民医院宝山分院接诊的85例脓毒血症所致急性肾衰竭患者的临床资料,按治疗方式分为观察组45例和对照组40例,两组均接受连续静脉血液透析治疗,对照组使用常规剂量进行透析,观察组使用高剂量进行透析。比较两组肾功能、炎症因子、免疫功能的变化及肾功能恢复时间、ICU停留时间和28 d死亡率。结果透析24 h后,观察组血肌酐(SCr)、尿素氮(BUN)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和IL-10水平均明显低于对照组,差异有统计学意义(P<0.05)。观察组T淋巴细胞亚群CD3^+、CD4^+和CD4+/CD8^+水平均明显高于对照组,差异有统计学意义(P<0.05)。观察组肾功能恢复时间、ICU停留时间明显短于对照组,差异有统计学意义(P<0.05),两组28 d死亡率比较差异无统计学意义。结论与常规剂量相比,高剂量连续静脉血液透析在脓毒血症所致急性肾衰竭患者中效果更加显著,可有效调节炎症因子和免疫功能,帮助肾功能的短期恢复,临床应用价值高。

OBJECTIVE To study the effects of high-dose continuous venous hemodialysis on inflammatory and immune function in patients with sepsis-induced acute renal failure,to provide guidance for clinical diagnosis and treatment. METHODS The clinical data of 85 patients with sepsis-induced acute renal failure in target hospital from January,2016 to January,2019 were retrospectively analyzed,and they were divided into observation group(45 cases)and control group(40 cases)by the different treatment methods. They were treated with continuous venous hemodialysis. The control group were treated with routine dosage for dialysis,while the observation group were treated with high dosage for dialysis. The changes of renal function,inflammatory factors,immune function,recovery time of renal function,ICU stay time and 28-day mortality were compared between these two groups. RESULTS After 24 hours dialysis,the serum creatinine(SCr),urea nitrogen(BUN),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10 levels in the observation group were significantly lower than the control group. The difference was statistically significant(P<0.05);the T lymphocyte subsets CD3^+,CD4^+and CD4^+/CD8+levels in the observation group were significantly higher than the control group,the difference was statistically significant(P<0.05);the recovery time of renal function and ICU stay time in the observation group were significantly shorter than the control group,and the difference was statistically significant(P<0.05). There was no significant difference in 28-day mortality between the two groups. CONCLUSION Compared with routine dosage,the high dose continuous venous hemodialysis was more effective in patients with sepsis-induced acute renal failure, which could effectively regulate inflammatory factors and immune function, help the short-term recovery of renal function,and had high clinical value.