不同治疗剂量CRRT对严重脓毒症合并急性肾损伤患者肠黏膜屏障功能和免疫功能的影响

Effects of Different Therapeutic Doses CRRT on Intestinal Mucosal Barrier Function and Immune Function in Severe Sepsis Patients with Acute Renal Injury

目的:探讨不同治疗剂量连续性肾脏替代治疗(CRRT)对严重脓毒症合并急性肾损伤患者肠黏膜屏障功能和免疫功能的影响。方法:选取2020年1月-2021年12月南华大学衡阳医学院,附属第二医院重症医学科收治的91例严重脓毒症合并急性肾损伤患者。根据随机数字表法将其分为A组(30例)、B组(30例)、C组(31例)。所有患者均给予常规治疗,并在常规治疗的基础上给予CRRT治疗。A组治疗剂量为35 ml/(kg·h),B组治疗剂量为40 ml/(kg·h),C组治疗剂量为65 ml/(kg·h)。比较三组治疗前及治疗7 d后肠黏膜屏障功能、免疫功能及预后情况。结果:治疗7 d后,三组二胺氧化酶(DAO)、细菌内毒素(BT)、D-乳酸(D-Lac)水平均降低,且C组DAO、BT、D-Lac水平均低于A组和B组(P<0.05)。治疗7 d后,三组白细胞分化抗原4阳性(CD4^(+))、CD4^(+)/白细胞分化抗原8阳性(CD8^(+))均上升,CD8^(+)均下降,且C组CD4^(+)、CD4^(+)/CD8^(+)均高于A组和B组,CD8^(+)低于A组和B组(P<0.05)。C组尿量恢复时间、ICU住院时间及机械通气治疗时间均短于A组、B组,C组急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分低于A组、B组(P<0.05)。结论:与小治疗剂量和中治疗剂量相比,大治疗剂量CRRT可更好地改善严重脓毒症合并急性肾损伤患者肠黏膜屏障功能,提高免疫功能,并改善预后。

Objective:To investigate the effects of different therapeutic doses continuous renal replacement therapy(CRRT)on intestinal mucosal barrier function and immune function in severe sepsis patients with acute renal injury.Method:From January 2020to December 2021,91 patients with severe sepsis and acute renal injury in Department of Critical Care Medicine of the Second Affiliated Hospital,Hengyang Medical College,Nanhua University were selected.They were divided into group A(30 cases),group B(30 cases)and group C(31 cases)according to the method of random number table.All patients were given routine treatment,and CRRT was given on the basis of routine treatment.The therapeutic dose of group A was 35 ml/(kg·h),group B was 40 ml/(kg·h),and group C was 65 ml/(kg·h).The intestinal mucosal barrier function,immune function before and after 7 d of treatment and prognosis condition of the three groups were compared.Result:After 7 d of treatment,the levels of diamine oxidase(DAO),bacterial endotoxin(BT)and D-lactic acid(D-Lac)in the three groups decreased,and the levels of DAO,BT and D-Lac in group C were lower than those in group A and group B(P<0.05).After 7 d of treatment,the leukocyte differentiation antigen 4 positive(CD4^(+))and CD4^(+)/leukocyte differentiation antigen 8 positive(CD8^(+))in the three groups increased,while the CD8^(+)decreased,CD4^(+)and CD4^(+)/CD8^(+)in group C were higher than those in group A and group B,while CD8^(+)was lower than that in group A and group B(P<0.05).The recovery time of urine volume,hospitalization time in ICU and mechanical ventilation therapy time in group C were shorter than those in group A and group B,the score of acute physiology and chronic health statusⅡ(APACHEⅡ)in group C was lower than that in group A and group B(P<0.05).Conclusion:Compared with small and medium therapeutic doses,large therapeutic doses of CRRT can better improve intestinal mucosal barrier function,immune function and prognosis in patients with severe sepsis and acute renal injury.