连续性血液滤过对产后重症急性肾功能衰竭患者免疫反应和炎症反应的影响

Effect of continuous venovenous hemofiltration on immune response and inflammatory response in postpartum patients with severe acute renal failure

目的 探讨连续性血液滤过(CVVH)对产后重症急性肾功能衰竭(ARF)患者免疫反应和炎症反应的影响。方法 选取2019年2月—2022年2月丽水市人民医院收治的80例产后重症ARF患者,随机分为对照组和观察组,每组各40例。对照组给予传统间歇性血液透析(IHD)治疗,观察组给予CVVH治疗。比较两组临床疗效,治疗前后的血液毒素指标[血清尿素氮(BUN)、血肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)]、细胞免疫反应指标(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值)、血清炎症反应指标[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)]、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分及序贯器官衰竭评估(SOFA)评分。结果 观察组总有效率为90.00%,明显高于对照组的72.50%(χ^(2)=4.021,P<0.05)。治疗后,观察组BUN、 Scr、 β_(2)-MG水平分别为(13.87±4.19)mmol/L、(150.36±22.13)μmol/L、(2.14±0.62)mg/L,均明显低于对照组的(17.79±4.65)mmol/L、(279.38±32.54)μmol/L、(3.31±0.78)mg/L,差异均有统计学意义(t=3.961、20.736、7.427,均P<0.05)。治疗后,观察组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)比值分别为(58.82±5.00)%、(35.49±3.05)%、(1.34±0.25),明显高于对照组的(54.54±4.46)%、(33.64±3.00)%、(1.17±0.33),差异均有统计学意义(t=4.040、2.735、2.597,均P<0.05)。治疗后,观察组CD8^(+)为(26.56±3.12)%,明显低于对照组的(28.63±3.33)%,差异有统计学意义(t=2.869,P<0.05)。治疗后,观察组血清hs-CRP、TNF-α、IL-1β水平分别为(3.72±1.15)mg/L、(8.11±2.10)ng/L、(10.38±2.68)pg/ml,均明显低于对照组的(4.52±1.24)mg/L、(12.25±3.33)ng/L、(14.38±3.00)pg/ml,差异均有统计学意义(t=2.992、6.651、6.289,均P<0.05)。治疗后,观察组APACHEⅡ和SOFA评分分别为(5.75±2.63)分和(3.32±1.10)分,均明显低于对照组的(9.73±3.65)分和(6.50±1.23)分,差异均有统计学意义(t=5.595、12.188,均P<0.05)。观察组不良反应总发生率为12.50%,略高于对照组的7.50%,差异无统计学意义(χ^(2)=0.139,P>0.05)。结论 相较于传统IHD治疗,CVVH治疗对产后重症ARF患者具有较好的临床疗效,可降低毒素因子水平,改善免疫功能,缓解炎症反应,降低APACHEⅡ和SOFA评分,安全性较好。

Objective To explore the effect of continuous venovenous hemofiltration(CVVH) on immune response and inflammatory response in postpartum patients with severe acute renal failure(ARF).Methods A total of 80 postpartum patients with severe ARF admitted to Lishui City People's Hospital from February 2019 to February 2022 were randomly divided into control group(40 cases) and observation group(40 cases).The patients in control group were treated with traditional intermittent hemodialysis(IHD).The patients in observation group were treated with CVVH.The clinical efficacies of the two groups were compared.Blood toxin indexes [blood urea nitrogen(BUN), serum creatinine(Scr), and β_(2)-microglobulin(β_(2)-MG)], indexes of cellular immune response(CD3^(+), CD4^(+), CD8^(+), and CD4^(+)/CD8^(+) ratio), indexes of serum inflammatory response [hypersensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)], acute physiology and chronic healthy evaluation Ⅱ(APACHE Ⅱ) scores, and sequential organ failure assessment(SOFA) scores before and after treatment in the two groups were compared.Results The total effective rate of observation group was 90.00%, which was significantly higher than that of control group(72.50%)(χ^(2)=4.021, P<0.05).After treatment, the levels of BUN, Scr, and β_(2)-MG in observation group were(13.87±4.19) mmol/L,(150.36±22.13) μmol/L, and(2.14±0.62) mg/L, respectively, which were significantly lower than those in control group [(17.79±4.65) mmol/L,(279.38±32.54) μmol/L,(3.31±0.78) mg/L](t=3.961, 20.736, 7.427, P<0.05).After treatment, the levels of CD3^(+), CD4^(+), and CD4^(+)/CD8^(+) ratio in observation group were(58.82±5.00)%,(35.49±3.05)%, and(1.34±0.25), respectively, which were significantly higher than those in control group [(54.54±4.46)%,(33.64±3.00)%, and(1.17±0.33)](t=4.040, 2.735, 2.597,P<0.05).After treatment, CD8^(+) level in observation group was(26.56±3.12)%, which was significantly lower than that in control group [(28.63±3.33)%](t=2.869, P<0.05).After treatment, the serum levels of hs-CRP, TNF-α, and IL-1β in observation group were(3.72±1.15) mg/L,(8.11±2.10) ng/L, and(10.38±2.68) pg/ml, respectively, which were significantly lower than those in control group [(4.52±1.24) mg/L,(12.25±3.33)ng/L,(14.38±3.00) pg/ml](t=2.992, 6.651, 6.289, P<0.05).After treatment, APACHE Ⅱ and SOFA scores of observation group were(5.75±2.63) and(3.32±1.10), respectively, which were significantly lower than those of control group [(9.73±3.65) and(6.50±1.23)](t=5.595, 12.188, P<0.05).The total incidence rate of adverse reactions in observation group was 12.50%, which was slightly higher than that in control group(7.50%), and the difference was not statistically significant(χ^(2)=0.139, P>0.05).Conclusion Compared with traditional IHD treatment, CVVH treatment has better clinical efficacy in postpartum patients with severe ARF, which can reduce the levels of blood toxin factors, improve immune function, alleviate inflammation, decrease APACHEⅡ and SOFA scores, and it has good safety.