连续性肾脏替代疗法叠加全血吸附治疗脓毒性休克对患者肾功能血清TLR4 cTnI水平的影响

Effects of Continuous Renal Replacement Therapy Combined with Hemadsorption on Renal Function and Levels of Serum TLR4 and CTnI in Treating Septic Shock

目的:观察连续性肾脏替代疗法(CRRT)叠加全血吸附治疗脓毒性休克对患者肾功能、血清Toll样受体4(TLR4)、心肌肌钙蛋白I(cTnI)水平的影响。方法:选用我院2018年10月至2020年10月收治的139例脓毒性休克患者为研究对象,依照随机数字表分层随机法将其分为对照组69例和观察组70例。对照组使用常规治疗方法,观察组则在其基础上联合CRRT叠加全血吸附。比较两组围术期基本情况(休克持续时间、下床活动时间、住院时间),对比治疗前、治疗1周后两组患者肾功能[血清胱抑素C(cysC)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、免疫功能[TLR4、核因子-κB(NF-κB)]、心肌功能[cTnI、肌酸激酶同工酶MB(CK-MB)]。结果:观察组休克持续时间、下床活动时间、住院时间均明显低于对照组(P<0.05)。治疗1周后,两组cysC、NGAL、TLR4、NF-κB、cTnI、CK-MB水平较治疗前均有显著降低(P<0.05),且观察组cysC、NGAL、NF-κB降低幅度均明显高于对照组(P<0.05)。结论:CRRT叠加全血吸附对脓毒性休克患者疗效显著,能有效改善其肾功能,清除炎症介质,降低血清TLR4、cTnI水平,具有较高临床应用价值。

Objective:To observe the effects of continuous renal replacement therapy(CRRT)combined with hemadsorption on renal function and levels of serum Toll-like receptor 4(TLR4)and cardiac troponin I(cTnI)in the treatment of septic shock.Methods:A total of 139 patients with septic shock treated in the hospital between October 2018 and October 2020 were selected as the research subjects,and they were divided into control group(69 cases)and observation group(70 cases)according to the stratified randomization of the random number table method.The control group was given conventional treatment,and the observation group was given CRRT combined with hemadsorption on the basis of conventional treatment.The perioperative basic status(shock duration,ambulation time,hospital stay)were compared between the two groups,and the renal function[serum cystatin C(cysC),neutrophil gelatinase-associated lipocalin(NGAL)],immune function[TLR4,nuclear factor-κB(NF-κB)]and myocardial function[cTnI,creatine kinase isoenzyme MB(CK-MB)]of the two groups of patients were compared before treatment and 1 week after treatment.Results:The shock duration,ambulation time and hospital stay in observation group were significantly shorter than those in control group(P<0.05).1 week after treatment,the levels of cysC,NGAL,TLR4,NF-κB,cTnI and CK-MB in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease ranges of cysC,NGAL and NF-κB in observation group were significantly higher than those in the control group(P<0.05).Conclusion:CRRT combined with hemadsorption has a significant efficacy on patients with septic shock,and it can effectively improve the renal function,remove the inflammatory mediators,and reduce the levels of serum TLR4 and cTnI,with high clinical application value.