CRRT对脓毒症合并AKI患者免疫功能及预后的影响

Effect of CRRT on immune function and prognosis in patients with sepsis c omplicated with AKI

目的:探讨连续性肾脏替代治疗(CRRT)对脓毒症合并急性肾脏损伤(AKI)患者的免疫功能及预后影响。方法:选取2020年2月至2021年11月期间济南市中西医结合医院收治的脓毒症合并AKI患者94例作为研究对象,随机分为对照组(n=47)和观察组(n=47)。对照组采用常规方案治疗,观察组在对照组的基础上行CRRT。对比两组的T淋巴细胞亚群水平、血清炎性因子水平、病死率及急性生理学与慢性健康状况评分系统(APACHE-Ⅱ)评分。结果:治疗后,两组的CD3^(+)T细胞、CD4^(+)T细胞及CD4^(+)T细胞/CD8^(+)T细胞均较治疗前升高,且观察组升高的幅度更大(P<0.05)。治疗后,两组的血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均较治疗前降低,且观察组降低的幅度更大(P<0.05)。观察组的28 d内病死率为2.13%,显著低于对照组的14.89%(P<0.05)。治疗后,观察组的APACHE-Ⅱ评分为(4.87±2.36)分,显著低于对照组的(6.55±2.18)分(P<0.05)。结论:CRRT对脓毒症合并AKI患者的免疫功能和炎症反应有良好的改善效果,有助于降低患者的病死率,改善其预后。

Objective:To investigate the effects of continuous renal replacement therapy(CRRT)on immune function and prognosis in patients with sepsis complicated with acute kidney injury(AKI).Methods:A total of 94 patients with sepsis combined with AKI admitted to Jinan Hospital of Integrated Chinese and Western Medicine from February 2020 to November 2021 were selected as the study objects,and randomly divided into control group(n=47)and observation group(n=47).The control group was treated with conventional regimen,and the observation group was treated with CRRT on the basis of the control group.The levels of T lymphocyte subsets,serum inflammatory factors,mortality and acute Physiology and Chronic Health status score system(APACHE-II)were compared between the two groups.Results:After treatment,the levels of CD3^(+)T cells,CD4^(+)T cells and CD4^(+)T cells/CD8^(+)T cells in both groups were higher than before treatment,and the increases in observation group were greater(P<0.05).After treatment,the serum levels of hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in both groups were decreased compared with those before treatment,and the reduction range was greater in observation group(P<0.05).The 28-day mortality in the observation group was 2.13%,which was significantly lower than that in the control group(14.89%)(P<0.05).After treatment,the APACHE-Ⅱscore of observation group was(4.87±2.36)points,which was significantly lower than that of control group(6.55±2.18)points(P<0.05).Conclusion:CRRT can improve the immune function and inflammatory response of patients with sepsis complicated with AKI,and help to reduce the mortality and improve the prognosis of patients.