连续血液净化对脓毒症患儿血清肌钙蛋白、纤维蛋白原及炎性因子表达的影响

Effects of continuous blood purification on the expressions of serum troponin,fibrinogen and inflammatory factors in children with sepsis

目的探究连续血液净化(CBP)对脓毒症患儿血清肌钙蛋白(Tn)、纤维蛋白原(Fib)及白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)表达的影响。方法选取2014年8月—2019年8月湖北省妇幼保健院儿童重症医学科诊治脓毒症患儿260例,以随机数字表法分为观察组和对照组各130例。对照组给予常规治疗,观察组在对照组治疗基础上给予CBP治疗。治疗3 d后比较2组患儿治疗前后血清心肌肌钙蛋白I(cTnI)、cTnT、Fib、激活全血凝固时间(ACT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、炎性因子[IL-6、TNF-α、C-反应蛋白(CRP)]、细胞免疫功能(CD3^(+)、CD4^(+)、CD8^(+))、肾功能[尿素氮(BUN)、肌酐(SCr)、钾离子(K^(+))]的变化情况。结果治疗后,2组患者cTnI、cTnT、Fib、IL-6、TNF-α、CRP、BUN、SCr、K^(+)水平均较治疗前降低,且观察组显著低于对照组(t/P=7.467/<0.001,58.394/<0.001,13.064/<0.001,6.129/<0.001,2.954/0.003,4.834/<0.001,11.732/<0.001,2.510/0.013,4.823/<0.001);2组患者CD3^(+)、CD4^(+)、CD8^(+)T细胞亚群百分比均较治疗前升高,且观察组显著高于对照组(t/P=5.713/<0.001,5.832/<0.001,3.880/<0.001);2组患者治疗前后ACT、APTT、PT比较差异无统计学意义(P>0.05)。结论CBP治疗能够显著降低脓毒症患儿血清cTnI、cTnT、Fib及炎性因子水平,改善细胞免疫功能和肾功能,具有较好的临床应用价值。

Objective To explore the effect of continuous blood purification(CBP)on the expressions of serum troponin(Tn),fibrinogen(Fib),interleukin 6(IL-6)and tumor necrosis factorα(TNF-α)in children with sepsis.Methods From August 2014 to August 2019,260 children with sepsis diagnosed and treated by the Department of Pediatric Intensive Medicine of Hubei Maternal and Child Health Hospital were selected and divided into the observation group and the control group with 130 cases in each group by random number table method.The control group was given routine treatment,and the observation group was given CBP treatment on the basis of the treatment of the control group.After 3 days of treatment,the serum cardiac troponin I(cTnI),cTnT,Fib,activated whole blood coagulation time(ACT),activated partial thromboplastin time(APTT)and prothrombin time(PT),inflammatory factors[IL-6,TNF-α,C-reactive protein(CRP)],cellular immune function(CD3^(+),CD4^(+),CD8^(+)),renal function[Burea nitrogen(BUN),creatinine(SCr),potassium ion(K^(+))]changes were compared between the two groups before and after treatment.Results After treatment,the levels of cTnI,cTnT,Fib,IL-6,TNF-α,CRP,BUN,SCr and K^(+)in the two groups were lower than those before treatment,and the observation group was significantly lower than the control group(t/P=7.467/<0.001,58.394/<0.001,13.064/<0.001,6.129/<0.001,2.954/0.003,4.834/<0.001,11.732/<0.001,2.510/0.013,4.823/<0.001).The percentages of CD3^(+),CD4^(+),CD8^(+)T cell subsets were higher than those before treatment,and the observation group was significantly higher than the control group(t/P=5.713/<0.001,5.832/<0.001,3.880/<0.001);There was no statistically significant difference in PT(P>0.05).Conclusion CBP treatment can significantly reduce the levels of serum cTnI,cTnT,Fib and inflammatory factors in children with sepsis,improve cellular immune function and renal function,and has good clinical application value.