持续低效血液透析联合血液灌流治疗脓毒症致急性肾损伤对患者血常规及炎性应激的影响

Effects of sustained low-efficiency dialysis combined with hemoperfusion on routine blood indicators and inflammatory factors in patients with sepsis-induced acute kidney injury

目的探讨持续低效血液透析(SLED)联合血液灌流(HP)治疗脓毒症致急性肾损伤(AKI)对患者血常规及炎性应激的影响。方法选择2018年4月至2021年4月烟台市莱阳中心医院收治86例脓毒症致AKI患者为研究对象,以简单随机数字表法分为观察组、对照组,各43例。两组均接受常规支持治疗,在此基础上对照组接受连续性肾脏替代治疗(CRRT),观察组接受SLED联合HP治疗。比较两组治疗前后血常规[血红蛋白(Hb)、白细胞计数(WBC)、血小板计数(PLT)、白蛋白(Alb)]、炎性应激[白细胞介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)]、肾功能[血肌酐(Scr)、尿素氮(BUN)]指标及急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)、ICU住院天数、28 d病死率。结果治疗前,两组患者Hb、WBC、PLT、Alb、IL-6、CRP、TNF-α、PCT、Scr、BUN水平及APACHEⅡ评分比较,差异均无统计学意义(t=0.04、0.95、0.23、0.67、1.54、0.75、0.98、0.23、1.04、0.44、0.07,均P>0.05);治疗后,两组患者Hb、Alb水平均明显高于治疗前,且观察组[(105.29±15.80)g/L、(39.25±7.87)g/L]均高于对照组[(98.55±12.93)g/L、(33.38±7.29)g/L](t=2.16、3.58,均P<0.05),两组患者WBC、PLT、IL-6、CRP、TNF-α、PCT、Scr、BUN水平及APACHEⅡ评分均明显低于治疗前,且观察组[(10.28±1.87)×10^(9)/L、(129.32±14.79)×10^(9)/L、(59.00±12.77)μg/L、(22.41±5.01)mg/L、(28.41±4.77)μg/L、(18.41±2.78)μg/L、(162.01±21.04)μmol/L、(7.38±1.17)mmol/L、(11.28±3.60)分]均低于对照组[(12.32±2.27)×10^(9)/L、(137.39±18.30)×10^(9)/L、(79.35±14.36)μg/L、(29.31±6.37)mg/L、(34.33±5.38)μg/L、(22.32±3.35)μg/L、(184.06±24.03)μmol/L、(9.87±1.66)mmol/L、(14.65±3.38)分](t=4.54、2.24、6.94、5.58、5.39、5.89、4.52、8.03、4.47,均P<0.05)。观察组ICU住院天数[(11.63±2.18)d]明显短于对照组的(14.07±2.71)d(t=4.60,P<0.05),两组28 d病死率比较,差异无统计学意义(χ^(2)=1.36,P>0.05)。结论SLED联合HP治疗脓毒症致AKI疗效尚可,可改善血常规指标,抑制炎性应激反应,促进肾功能恢复,一定程度降低患者病死率。

Objective To investigate the effects of sustained low-efficiency hemodialysis combined with hemoperfusion on routine blood indicators and inflammatory factors in patients with sepsis-induced acute kidney injury.Methods Eighty-six patients with sepsis-induced acute kidney injury who received treatment in Yantai Laiyang Central Hospital from April 2018 to April 2021 were included in this study.They were randomly divided into an observation group and a control group,with 43 cases in each group.All patients received conventional supportive treatment.The control group received continuous renal replacement therapy and the observation group received sustained low-efficiency dialysis combined with hemoperfusion.Before and after treatment,routine blood indicators[hemoglobin(Hb),white blood cell(WBC)count,platelet(PLT)count,albumin(Alb)],inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),procalcitonin PCT],renal function indicators[serum creatinine(Scr),blood urea nitrogen(BUN)],The Acute Physiology and Chronic Health Evaluation(APACHE)II score,length of hospital stay,and 28-day mortality rate were compared between the two groups.Results Before treatment,there were no significant differences in Hb,WBC count,PLT count,Alb,IL-6,CRP,TNF-α,PCT,Scr,BUN,and APACHE II score between the two groups(t=0.04,0.95,0.23,0.67,1.54,0.75,0.98,0.23,1.04,0.44,0.07,all P>0.05).After treatment,serum levels of Hb and Alb in each group were significantly increased compared with those before treatment.After treatment,serum levels of Hb and Alb in the observation group were(105.29±15.80)g/L,(39.25±7.87)g/L,respectively,which were significantly higher than(98.55±12.93)g/L and(33.38±7.29)g/L in the control group(t=2.16,3.58,both P<0.05).After treatment,WBC count,PLT count,IL-6,CRP,TNF-α,PCT,Scr,and BUN levels,and APACHE II score in each group were significantly decreased compared with those before treatment.After treatment,WBC count,PLT count,IL-6,CRP,TNF-α,PCT,Scr,and BUN levels,and APACHE II score in the observation group were(10.28±1.87)×10^(9)/L,(129.32±14.79)×10^(9)/L,(59.00±12.77)μg/L,(22.41±5.01)mg/L,(28.41±4.77)μg/L,(18.41±2.78)μg/L,(162.01±21.04)μmol/L,(7.38±1.17)mmol/L,(11.28±3.60)points,respectively,which were significantly lower than(12.32±2.27)×10^(9)/L,(137.39±18.30)×10^(9)/L,(79.35±14.36)μg/L,(29.31±6.37)mg/L,(34.33±5.38)μg/L,(22.32±3.35)μg/L,(184.06±24.03)μmol/L,(9.87±1.66)mmol/L,(14.65±3.38)points in the control group(t=4.54,2.24,6.94,5.58,5.39,5.89,4.52,8.03,4.47,all P<0.05).The length of intensive care unit stay in the observation group was significantly shorter than that in the control group[(11.63±2.18)days vs.(14.07±2.71)days,t=4.60,P<0.05].There was no significant difference in 28-day mortality rate between the two groups(χ^(2)=1.36,P>0.05).Conclusion Sustained low-efficiency dialysis combined with hemoperfusion is effective on sepsis-induced acute kidney injury.The combined therapy can improve routine blood indicators,inhibit inflammatory reactions,promote renal function recovery,and decrease the mortality rate to a certain degree.