连续性血浆吸附联合血浆滤过治疗对脓毒症急性肾损伤患者免疫功能及预后的影响

doi:10.3969/j.issn.1006-6233.2017.08.042

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摘要 目的: 探讨连续性血浆吸附联合血浆滤过治疗脓毒症急性肾损伤后对患者免疫功能及预后影响。方法: 选取脓毒症急性肾损伤患者64例,随机分为两组,各32例,均给予抗感染、机械通气、液体复苏、控制血糖、纠正酸中毒及电解质紊乱、营养支持等治疗。对照组采取连续性肾脏替代治疗(CRRT)方案,实验组予连续性血浆吸附滤过(CPFA)方案。治疗结束后,比较两组患者血清炎症因子水平、免疫功能、生化指标及30d生存率与ICU停留时间。结果: 治疗前,两组患者血清炎症因子水平、免疫功能、生化指标等指标水平对比,差异不具有统计学意义(P>0.05)。治疗后,两组患者血清hs-CRP、IL-6、IL-1及TNF-α水平均显著降低(P<0.05);血清IgG,IgA,IgM水平显著升高,实验组患者CD4⁺水平明显上升,CD8⁺水平明显下降(P<0.05);血清WBC,尿素,肌酐水平降低,实验组患者PLT及N水平较治疗前变化显著(P<0.05)。组间比较,实验组患者血清hs-CRP、IL-6、IL-1及TNF-α水平显著低于对照组患者(P<0.05);血清IgG,IgA,IgM水平显著高于对照组患者(P<0.05);血清WBC,尿素,肌酐水平显著低于对照组患者(P<0.05)。对照组患者30d存活率62.50%(20/32)低于实验组30d存活率84.38%(27/32)(P>0.05),ICU停留时间(15.31±2.21)d明显高于实验组患者ICU停留时间(11.22±2.84)d(P<0.05)。结论: 连续性血浆吸附联合血浆滤过对脓毒症急性肾损伤具有较好的临床疗效,能够显著改善患者免疫功能,降低血清炎症因子,改善预后,具有较好的临床推广意义。

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关键词 ：连续性血浆吸附联合血浆滤过, 脓毒症, 急性肾损伤, 免疫功能

Abstract：Objective: To investigate the effect continuous plasma adsorption combined with plasma filtration therapy on immune function and prognosis of patients with acute renal injuryinduced by sepsis. Methods: A total of 64 patients with acute renal injury were randomly divided into treatment group and control group, 32 cases each. All the patients were treated with anti infection, mechanical ventilation, liquid resuscitation, blood glucose control, correct acidosis and electrolyte disturbance, nutritional support. The control group was treated with continuous renal replacement therapy (CRRT), and the treatment group was treated with continuous plasma filtration (CPFA), the levels of serum inflammatory factors, immune function, biochemical indexes and the 30 survival rate and ICU stay time were compared between the two groups. Results: Before treatment, the immune function of two groups of patients with serum levels of inflammatory factors, and biochemical indexes such as the level of comparison, the difference was not statistically significant (P>0.05).After treatment, two groups of patients with serum hs-CRP, IL-6, IL-1 and TNF- levels were significantly decreased (P < 0.05);Serum IgG, IgA, IgM levels were significantly higher in the experimental group, the level of CD4⁺ increased obviously, the level of CD8⁺ was significantly decreased (P < 0.05);Serum WBC, urea, creatinine levels decreased, patients in the experimental group PLT and N levels than before treatment significantly (P < 0.05)。Comparison between groups of patients in the experimental group, serum hs-CRP, IL-6, IL-1 and TNF- levels significantly lower than the control group (P < 0.05);Serum IgG, IgA, IgM levels significantly higher than the control group (P < 0.05);Serum WBC, urea, creatinine level was significantly lower than that of the control group (P < 0.05)。The control group of 30 patients with D survival rate was 62.50% (20/32) lower than the experimental group 30 d survival rate was 84.38% (27/32) (P>0. 05), ICU residence time (15.31 + 2.21) d was significantly higher than the patients in the experimental group ICU retention time (11.22 + 2.84) d (P < 0.05). Conclusions: Continuous plasma filtration adsorption combined with plasma has good clinical curative effect on acute kidney injury and sepsis, it can significantly improve the immune function of patients, reduce serum inflammatory factors, improve the prognosis, has better clinical significance.

Key words： Continuous plasma adsorption combined with plasma filtration Sepsis Acute kidney injury Immune function

基金资助:重庆市2014年度第三军医大学附属新桥医院临床科研项目,(编号:2014YLC18)

通讯作者: 赵景宏,Email:suans8247553@163.com

引用本文:

雷湫宇, 王沂芹, 王代红, 聂凌, 赵景宏. 连续性血浆吸附联合血浆滤过治疗对脓毒症急性肾损伤患者免疫功能及预后的影响[J]. 河北医学, 2017, 23(8): 1378-1382.
LEI Qiuyu, WANG Yiqin, WANG Daihong, et al. Effects of Continuous Plasma Adsorption combined with Plasma Filtration Therapy on Immune Function and Prognosis in Patients with Acute Kidney Injury Induced by Sepsis. 河北医学, 2017, 23(8): 1378-1382.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2017.08.042 或 http://www.hbyxzzs.cn/CN/Y2017/V23/I8/1378

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