连续性肾脏替代治疗治疗对脓毒症急性肾损伤患者尿ALR、NHE3及血IL-18水平的影响

Effect of CRRT on urinary ALR,NHE3 and blood IL-18 levels in patients with acute renal injury of sepsis.

目的观察脓毒症急性肾损伤治疗中连续性肾脏替代治疗(CRRT)的应用效果及对患者血白细胞介素-18(IL-18)、尿Na/H交换体亚型3(NHE3)、肝再生增强因子(ALR)水平的影响。方法前瞻性选取2015年1月至2019年11月长江大学附属仙桃市第一人民医院收治的95例脓毒症急性肾损伤患者,按照随机平行分组法将其分为两组:对照组(n=47)和研究组(n=48)。对照组采用常规抗脓毒症治疗,研究组在常规抗脓毒症的基础上采用CRRT治疗。比较两组患者治疗前后脓毒症指标(降钙素原、中性粒细胞比率、白细胞计数)、IL-18、NHE3、ALR与治疗后ICU住院时间、心血管事件发生率、尿量恢复时间。结果治疗后,研究组患者的降钙素原、中性粒细胞比率、白细胞计数、IL-18、NHE3、ALR、ICU住院时间、心血管事件发生率、尿量恢复时间依次为(8.14±1.95)ng/mL、(88.03±3.14)%、(16.52±2.04)×109/L、(43.08±6.14)ng/L、(124.82±15.45)pg/mL、(159.14±25.46)pg/mL、(9.27±3.41)d、10.42%、(7.86±2.61)d,对照组依次为(4.15±1.62)ng/mL、(78.42±3.35)%、(12.97±2.31)×109/L、(60.11±7.52)ng/L、(200.67±13.93)pg/mL、(220.76±27.08)pg/mL、(13.08±5.95)d、29.79%、(10.95±3.82)d。与对照组相比,研究组患者的治疗后降钙素原、中性粒细胞比率、白细胞计数、IL-18、NHE3、ALR水平与心血管事件发生率明显更低,且ICU住院时间、尿量恢复时间更短,差异均具有统计学意义(P<0.05)。结论脓毒症急性肾损伤治疗中CRRT的应用效果显著,可有效抑制脓毒症急性肾损伤进程,降低IL-18、NHE3、ALR水平,还可减少心血管事件,促使其快速康复。

Objective To study the effect of continuous renal replacement therapy(CRRT)in the treatment of acute renal injury of sepsis and its effect on interleukin-18(IL-18),urinary Na/H switched subtype 3(NHE3),and liver regeneration enhancement factor(ALR).Methods Prospective research method was performed.95 patients with acute sepsis with acute sepsis admitted to the First People's Hospital of Xiantao City,Yangtze University from January 2015 to November 2019 were selected and divided into two groups according to random parallel grouping:control Group(n=47)and research group(n=48).The control group was treated with conventional antiseptic treatment,and the research group was treated with CRRT on the basis of conventional antiseptic treatment.Comparison of sepsis indicators(procalcitonin,neutrophil ratio,white blood cell count),IL-18,NHE3,ALR and ICU hospital stay,incidence of cardiovascular events,urine recovery time after treatment before and after treatment was performed.Results After treatment,procalcitonin,proportion of neutrocytes,white blood cell count,IL-18,NHE3,ALR,length of ICU stay,incidence of cardiovascular events and recovery time of urine volume of the study group were(8.14±1.95)ng/mL,(88.03±3.14)%,(16.52±2.04)×109/L,(43.08±6.14)ng/L,(124.82±15.45)pg/mL,(159.14±25.46)pg/mL,(9.27±3.41)d,10.42%,(7.86±2.61)d;these metrics of the control group were(4.15±1.62)ng/ml,(78.42±3.35)%,(12.97±2.31)×109/L,(60.11±7.52)ng/L,(200.67±13.93)pg/mL,(220.76±27.08)pg/mL,(13.08±5.95)d,29.79%,(10.95±3.82)d.Compared with the control group,procalcitonin,proportion of neutrophils,white blood cell count,IL-18,NHE3,ALR level and incidence of cardiovascular events were significantly lower in the study group after treatment,and ICU stay and urine volume recovery time were shorter,the differences were statistically significant(P<0.05).Conclusion The application of CRRT in the treatment of acute renal injury in sepsis has a significant effect,which can effectively inhibit the process of acute renal injury in sepsis,reduce the levels of IL-18,NHE3 and ALR,reduce cardiovascular events and promote rapid recovery.