连续肾替代治疗慢性肾衰竭重症患者的疗效及其预后的影响因素分析

Efficacies of continuous renal replacement therapy for severe patients with chronic renal failure and the influencing factors of long-term prognosis

目的探究连续肾替代治疗(continuous renal replacement therapy,CRRT)慢性肾衰竭(chronic renal failure,CRF)重症患者的临床疗效,分析远期预后的影响因素。方法选择2018年9月至2021年4月我院收治的160例CRF重症患者为研究对象。按照治疗方法,观察组120例采用连续肾替代治疗,对照组40例采用血液透析治疗。所有患者入组后给予常规治疗,对照组采用血液透析治疗,观察组行CRRT治疗;比较两组实验室指标及治疗后不良反应发生率。多因素Logistic回归分析连续肾替代治疗CRF重症患者远期预后的影响因素;构建连续肾替代治疗CRF重症远期预后的列线图预测模型,并采用受试者工作特征曲线(receiver operating characteristic,ROC)曲线和校准曲线带对列线图模型进行区分度和校准度评价。结果治疗前,两组患者β2微球蛋白(β2-microglobulin,β2-MG)、血肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、白介素1(interleukin-1,IL-1)、白介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor,TNF-α)、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、同型半胱氨酸(homocysteine,Hcy)、甲状旁腺素(parathyroid hormone,PTH)、血磷、尿酸水平比较,均差异无统计学意义(P>0.05)。治疗后,观察组患者β2-MG、Scr、BUN水平低于对照组,且与治疗前相比,两组患者β2-MG、Scr、BUN水平均降低;观察组患者IL-1、IL-6、TNF-α、hs-CRP、Hcy、PTH、血磷、尿酸水平与对照组相比均较低;观察组不良反应发生率显著低于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,高血压、心力衰竭、维持血液透析时间≥1年是CRRT远期预后的危险因素,而血清白蛋白水平≥30 g/L是CRRT远期预后的保护因素。列线图模型及区分度、校准度进行评价结果良好。结论连续肾替代治疗CRF重症患者的临床疗效显著,同时患者高血压、心力衰竭、维持血液透析时间≥1年的并发症方面,CRF患者远期预后较差。

Objective To explore the clinical efficacy of continuous renal replacement therapy(CRRT)for severe patients with chronic renal failure(CRF)and examine the influencing factors of longterm prognosis.Methods From September 2018 to April 2021,160 hospitalized severe CRF patients were selected as research subjects.According to treatment options,observation group received CRRT(n=120)while control group had hemodialysis(n=40).Both groups were treated conventionally after en⁃rollment.Renal function parameters[β2-microglobulin(β2-MG),serum creatinine(Scr)&blood urea nitrogen(BUN)]and the levels of microinflammatory factors[interleukin-1/6(IL-1/6)&tumor necrosis factor-alpha(TNF-α)]were compared between two groups before and after treatment.IL-6,TNFα,high-sensitivity C-reactive protein(hs-CRP),parathyroid hormone(PTH),homocysteine(Hcy),uric acid,blood phosphorus and the incidence of adverse reactions after treatment all declined.Multivari⁃ate Logistic regression analysis was performed for the influencing factors of long-term prognosis of CRF patients on CRRT.A nomogram prediction model was constructed and receiver operating characteristic(ROC)curve and GiVITI calibration curve with a nomogram model were utilized for discrimination and calibration evaluations.Results Prior to treatment,no significant inter-group differences existed in the levels ofβ2-MG,Scr,BUN,IL-1,IL-6,TNF-α,hs-CRP,Hcy,PTH,blood phosphorus or uric acid(P>0.05).After treatment,the levels ofβ2-MG,Scr and BUN were lower in observation group than those in control group.And the levels ofβ2-MG,Scr and BUN dropped in two groups than pretreatment;the levels of IL-1,IL-6,BUN,TNF-α,hs-CRP,Hcy,PTH,blood phosphorus and uric acid were lower in observation group than those in control group;the incidence of adverse reactions was significantly lower in observation group than that in control group and the difference was statistically sig⁃nificant(P<0.05).Multivariate Logistic regression analysis indicated that hypertension,heart failure and maintenance of hemodialysis time≥1 year were risk factors for long-term prognosis of CRRT.Se⁃rum albumin level≥30 g/L was a protective factor for long-term prognosis of CRRT.Nomogram model,degree of discrimination and degree of calibration all yielded excellent results.Conclusion CRRT has significant clinical efficacies in severe CRF patients.And hypertension,the long-term progno⁃sis of CRF patients is worse for those with heart failure and complications of maintaining hemodialysis for more than 1 year.