脉冲式高容量血液滤过串联血液灌注对脓毒症急性肾功能损伤患者炎症因子水平及肾功能的影响

Removal of inflammatory cytokines by pulse high-volume hemofiltration cascade hemo perfus for protecting the acute kidney injury in patients with sepsis

目的探讨脉冲式高容量血液滤过联合血液灌注治疗对脓毒症急性肾损伤患者体内炎症因子的清除及对肾功能的保护作用。方法本研究为前瞻性、对照研究,选取60例2012年3月至2015年11月合肥市第二人民医院ICU脓毒症合并急性肾损伤患者进行随机分组。其中32例接受脉冲式高容量血液滤过串联血液灌流治疗,采用珠海丽珠公司HA330型大孔径中性树脂灌流器;28例仅接受常规治疗。所有患者均于治疗前和治疗后3 d、7 d分别抽外周血检测肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、C反应蛋白、降钙素原水平,并记录24 h尿量、肌酐、胱抑素C及尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。结果治疗前两组间TNF-α、IL-6水平及C反应蛋白、降钙素原、24 h尿量、肌酐、胱抑素C及尿NGAL水平比较,差异均无统计学意义(P>0.05);串联组及对照组在治疗后3 d、7 d血浆TNF-α、IL-6、C反应蛋白、降钙素原水平均下降,串联组较对照组下降更明显[(20.3±8.9)μg/L、(10.2±2.1)μg/L比(24.7±7.1)μg/L、(13.5±2.2)μg/L;(29.1±8.9)μg/L、(15.2±8.6)μg/L比(32.7±9.3)μg/L、(21.3±8.3)μg/L;(121.3±43.6)mg/L、(50.3±10.4)mg/L比(145.2±37.9)mg/L、(97.2±13.2)mg/L;(16.3±4.8)ng/ml、(4.7±1.2)ng/ml比(20.8±5.1)ng/ml、(9.2±1.0)ng/ml,P<0.05];同时,串联组尿量增加更显著,且血肌酐、胱抑素C及尿NGAL水平明显低于对照组[24 h尿量:(28.11±0.66)ml/h、(41.88±6.15)ml/h比(22.11±3.78)ml/h、(30.16±4.56)ml/h;肌酐:(198.48±59.43)μmol/L、(197.22±55.55)μmol/L比(251.91±37.21)μmol/L、(389.11±37.98)μmol/L;胱抑素C:(3.4±1.6)mg/L、(2.2±1.0)mg/L比(5.1±1.7)mg/L、(3.0±0.9)mg/L;尿NGAL:(4.21±0.27)ng/ml、(6.09±0.21)ng/ml比(6.78±0.98)ng/ml、(8.78±0.89)ng/ml,P<0.05]。结论脉冲式高容量血液滤过联合血液灌注治疗较单纯血液滤过可以更显著减轻脓毒症急性肾损伤患者体内炎症反应,并有利于肾功能恢复。

Objective To discuss the effect of removing inflammatory cytokines by pulse high-volume hemofiltration cascade hemo perfus on acute kidney injury in patients with sepsis. Methods A total of 60 patients with sepsis and acute kidney injury were randomly divided into two groups: Cascade group (n=32) and control groups (n=28). Hemoperfusion carried out in patients of Cascade group with HA330 filter, the patients of control group were treated with routine treatment. Further, the hemodynamics, plasma TNF-α, IL-6, C reactive protein (CRP), procalcitonin (PCT), urine output, serum creatinine (Scr), cystain C (Cys C) and urine NGAL of patients in both groups were detected before treatment and 3 days, 7&nbsp;days after treatment from peripheral blood. Results The levels of plasma interleukins TNF-α, IL-6, CRP, PCT, the urine volume, blood Scr, Cys C and urine NGAL between the two groups before treatment were not changed remarkably (all P>0.05). Both series connection group and control group, after treatment for 3 d, 7 d, the levels of plasma interleukins TNF-α, IL-6, CRP, PCT were significantly lower. Compared with the control group the series connection group decreased significantly [(20.3±8.9)μg/L, (10.2±2.1)μg/L vs. (24.7±7.1)μg/L, (13.5±2.2)μg/L; (29.1±8.9)μg/L, (15.2±8.6)μg/L vs. (32.7±9.3)μg/L, (21.3±8.3)μg/L;(121.3±43.6)mg/L, (50.3±10.4)mg/L vs. (145.2±37.9)mg/L, (97.2±13.2)mg/L; (16.3±4.8)ng/ml, (4.7±1.2) ng/ml vs. (20.8±5.1)ng/ml, (9.2±1.0)ng/ml, P<0.05]; And then, the urine volume increased significantly in the series connection group, lower levers of blood Scr, Cys C and urine NGAL: (the urine volume:(8.11±0.66)ml/h, (41.88±6.15)ml/h vs. (22.11±3.78)ml/h, (30.16±4.56)ml/h; Scr: (198.48±59.43)μmol/L, (197.22±55.55)μmol/L vs. (251.91±37.21)μmol/L, (389.11±37.98)μmol/L; Cys C: (3.4±1.6)mg/L, (2.2±1.0) mg/L vs. (5.1±1.7)mg/L, (3.0±0.9)mg/L; urine NGAL: (4.21±0.27)ng/ml, (6.09±0.21)ng/ml vs. (6.78±0.98) ng/ml, (8.78±0.89)ng/ml, P<0.05)Conclusions Pulse high-volume hemofiltration cascade hemo perfus can significantly reduce sepsis in patients with acute kidney injury inflammation in the body, and is advantageous to the renal function recovery.