连续性血液净化对脓毒血症合并急性肾损伤患者肾功能和炎性因子及免疫功能的影响

The effects of continuous blood purification on renal function,inflammatory factors and immune function in patients with sepsis combined with acute kidney injury

目的 分析连续性血液净化(CBP)对脓毒血症合并急性肾损伤患者肾功能、炎性因子及免疫功能的影响,以及对其微循环及预后的影响。方法 回顾性分析空军军医大学第一附属医院肾脏内科2022.3~2024.3收治的脓毒血症合并急性肾损伤(AKI)患者195例,将其中采用常规治疗的97例患者纳入为常规组,在常规基础上进行CBP治疗的98例患者纳入为CBP组。对比两组治疗前及治疗3 d后肾功能、炎性因子、免疫功能、微循环及预后。结果 两组年龄、性别、急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ评分)、AKI分级及原发疾病等基础数据对比,无统计学差异(P> 0.05)。肾功能:治疗后两组胆碱酯酶(CHE)上升、血清肌酐(SCr)和血尿素氮(BUN)下降,CBP组CHE升高及SCr和BUN降低水平均高于常规组(P <0.05)。炎性因子:治疗后两组肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、白介素-6(IL-6)下降,且CBP组TNF-α、hs-CRP、PCT、IL-6降低水平均高于常规组(P <0.05)。免疫功能:治疗后两组CD4+、CD4+/CD8+及CD3+上升,且CBP组免疫指标升高水平均高于常规组(P <0.05)。微循环:治疗后两组微血管流动指数(MFI)、灌注血管比例(PPV)上升,全身血管阻力指数(SVRI)下降,且CBP组MFI、PPV升高及SVRI降低水平均高于常规组(P <0.05)。预后:治疗后两组序贯器官衰竭(SOFA)、APACHEⅡ评分下降,且CBP组SOFA、APACHEⅡ降低水平均高于常规组(P <0.05)。CBP组患者ICU住院时间及肾功能恢复时间均明显短于常规组,且有统计学意义(t=5.449,8.281,均P <0.05)。两组生存率和死亡率比较均无统计学意义(χ^(2)=1.241,1.768,均P> 0.05)。CBP组不良反应发生率较低(χ^(2)=5.130,P <0.05)。结论 CBP用于脓毒血症合并急性肾损伤患者中,可有效纠正炎症状态,改善肾功能及免疫功能,同时还可恢复机体微循环功能,有助于预后改善。

Objective To analyze the impact of continuous blood purification(CBP)on the renal function,inflammatory factors,and immune function in patients with sepsis combined with acute kidney injury,as well as its effects on microcirculation and prognosis.Methods A retrospective analysis was performed on 195 patients with sepsis combined with acute kidney injury who were admitted to the Department of Nephrology at the First Affiliated Hospital of Air Force Medical University from March 2022 to March 2024.97 patients receieved conventional treatment were included in the routine group,and 98 patients receieved CBP treatment in addition to routine treatment were included in the CBP group.The renal function,inflammatory factors,immune function,microcirculation,and prognosis before treatment and 3 days after treatment in the two groups were compared.Results Comparison of basic data such as age,gender,Acute Physiology and Chronic Health Status ScoreⅡ(APACHEⅡscore),AKI classification and primary disease between the two groups did not show any statistically significant difference(P>0.05).After treatment,choline esterase(CHE)increased but serum creatinine (SCr) and blood urea nitrogen (BUN) decreased in both groups. The CBP group showed a higher increase in CHE and a greater decrease in SCr and BUN than the control group (P < 0.05);Tumour necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and interleukin-6 (IL-6) decreased in both groups. The CBP group showed a greater decrease in TNF-α, hs-CRP, PCT, and IL-6 than the control group (P < 0.05);CD4+, CD4+/CD8+, and CD3+ increased in both groups. with the CBP group showed a higher increase in immune indicators than the control group (P < 0.05);The microvascular flow index (MFI) and perfusion vessel ratio (PPV) increased, while the peripheral vascular resistance index (SVRI) decreased in both groups, The CBP group showed a higher increase in MFI and PPV as well as a greater decrease in SVRI compared to the control group (P < 0.05);The SOFA and APACHE Ⅱ scores decreased in both groups, The CBP group showed a greater decrease in SOFA and APACHE Ⅱ than the control group (P < 0.05). The duration of ICU stay and the time for renal function recovery in the CBP group were significantly shorter than those in the control group, with statistical significance (t = 5.449, 8.281, P < 0.05). There was no statistically significant difference in survival or mortality rates between the two groups (χ^(2) = 1.241, 1.768, P > 0.05). The incidence of adverse reactions in the CBP group was lower than the control group ( χ^(2) = 5.130, P < 0.05). Conclusion CBP is effective in correcting the inflammatory state, improving renal function and immune function in patients with sepsis combined with acute kidney injury, and it can also restore the body’s microcirculatory function, which is beneficial for improving the prognosis.