连续性血液净化治疗对慢性肾...标、肾功能及免疫功能的影响_李华.pdf

Hainan Med J,Feb.2023.Vol.34,No.4海南医学2023年2月第34卷第4期连续性血液净化治疗对慢性肾衰竭合并SIRS患者炎症指标、肾功能及免疫功能的影响李华1，刘玉刚2，雷鑫3，申爱宁4榆林市第一医院肾病风湿免疫科1、泌尿外科2、血液净化科3、肾内科4，陕西榆林719000【摘要】目的探讨连续性血液净化治疗对慢性肾衰竭合并全身炎症反应综合征(SIRS)患者炎症指标、肾功能及免疫功能的影响。方法回顾性分析2019年1月至2022年1月于榆林市第一医院治疗的85例慢性肾衰竭合并SIRS患者的临床资料，按照治疗方法不同分为对照组(n=41，基础治疗)和研究组(n=44，连续性血液净化治疗)。比较两组患者治疗前后的炎症指标白介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-(TNF-)、肾功能血肌酐(Cr)、尿素氮(BUN)、碱酯酶(CHE)、免疫功能(CD3+、CD4+、CD8+)水平。结果治疗后，两组患者的IL-6、PCT、TNF-水平均显著下降，且治疗后研究组患者的IL-6、PCT、TNF-水平分别为(32.265.28)ng/L、(1.010.29)ng/L、(7.642.66)ng/mL，明显低于对照组的(46.394.17)ng/L、(2.810.82)ng/L、(12.693.58)ng/mL，差异均有统计学意义(P0.05)；治疗后，两组患者的Cr、BUN水平均明显下降，而CHE均明显上升，且治疗后研究组患者的Cr、BUN水平分别为(343.6982.09)mol/L、(17.644.41)mol/L，明显低于对照组的(496.3890.68)mol/L、(26.484.29)mol/L，CHE水平为(5 025.63443.56)U/L，明显高于对照组的(3 259.58320.47)U/L，差异均有统计学意义(P0.05)；两组患者治疗后的CD3+、CD4+水平明显上升，CD8+明显下降，且治疗后研究组患者的CD3+、CD4+水平分别为(69.382.95)%、(48.684.29)%，明显高于对照组的(61.352.63)%、(40.263.57)%，CD8+水平为(25.363.61)%，明显低于对照组的(28.683.27)%，差异均有统计学意义(P0.05)。结论连续性血液净化治疗可有效改善慢性肾衰竭合并SIRS患者的炎症指标、肾功能及免疫功能，具有临床应用价值。【关键词】慢性肾衰竭；全身炎症反应综合征；连续性血液净化治疗；炎症指标；肾功能；免疫功能【中图分类号】R692.5【文献标识码】A【文章编号】10036350（2023）04048904Effects of continuous blood purification therapy on inflammatory indexes,renal function,and immune functionin patients with chronic renal failure complicated with systemic inflammatory response syndrome.LI Hua1,LIUYu-gang2,LEI Xin3,SHEN Ai-ning4.Department of Nephrology,Rheumatism and Immunology1,Department of UrinarySurgery2,Department of Blood Purification3,Department of Nephrology4,the First Hospital of Yulin,Yulin 719000,Shaanxi,CHINA【Abstract】ObjectiveTo investigate the effect of continuous blood purification therapy on inflammatory index-es,renal function,and immune function in patients with chronic renal failure complicated with systemic inflammatory re-sponse syndrome(SIRS).MethodsThe clinical data of 85 patients with chronic renal failure combined with SIRS whowere treated in the First Hospital of Yulin from January 2019 to January 2022 were retrospectively analyzed,and accord-ing to different treatment methods,they were divided into control group(n=41,basic treatment)and study group(n=44,continuous blood purification treatment).The inflammatory indicators interleukin-6(IL-6),procalcitonin(PCT),tumornecrosis factor(TNF-),renal function creatinine(Cr),blood urea nitrogen(BUN),alkaline esterase(CHE),immunefunction(CD3+,CD4+,CD8+)levels of the two groups before and after treatment were compared.ResultsAfter treat-ment,IL-6,PCT,TNF-levels of the patients in the two groups decreased significantly,and the levels of IL-6,PCT,and TNF-in the study group after treatment were(32.265.28)ng/L,(1.010.29)ng/L,and(7.642.66)ng/mL,respec-tively,which were significantly lower than(46.394.17)ng/L,(2.810.82)ng/L,and(12.693.58)ng/mL in the controlgroup(P0.05).After treatment,Cr and BUN levels in both groups significantly decreased,while CHE significantly in-creased;the levels of Cr and BUN in the study group after treatment were(343.6982.09)mol/L,(17.644.41)mol/L,respectively,which were significantly lower than(496.3890.68)mol/L,(26.484.29)mol/L in the control group;thelevel of CHE in the study group was(5 025.63443.56)U/L,which was significantly higher than(3 259.58320.47)U/Lin the control group;the differences were statistically significant(P0.05)，具有可比性，见表1。本研究经医院医学伦理委员会批准。higher than(61.352.63)%and(40.263.57)%in the control group;the level of CD8+in the study group was(25.363.61)%,which was significantly lower than(28.683.27)%in the control group;the differences were statistically signifi-cant(P0.05).ConclusionContinuous blood purification treatment can effectively improve the inflammatory indica-tors,renal function and immune function of patients with chronic renal failure and SIRS,which has significant clinicalapplication value.【Key words】Chronic renal failure;Systemic inflammatory response syndrome;Continuous blood purificationtherapy;Inflammatory markets;Renal function;Immune function表1两组患者的一般资料比较x-s，例(%)Table 1Compare of general data between the two groups x-s,n(%)组别研究组对照组t/2值P值例数4441年龄(岁)40.286.8438.496.611.3560.178男/女24(54.55)/20(45.45)22(53.66)/19(46.34)0.0070.935高血压25(56.82)23(56.10)0.0050.947糖尿病21(47.73)20(48.78)0.0090.923冠心病23(52.27)22(53.66)0.0160.898病程(年)2.510.592.290.551.9650.052基础疾病1.2治疗方法对照组患者进行对症治疗，同时控制感染、加强营养支持并纠正水电解质紊乱。研究组患者在此基础上行连续性血液净化治疗。首先建立血管通路，应用血液滤过机治疗，配方根据患者情况进行配置，滤过时间：1024 h/d，置换液流量：12 L/h；低分子肝素首次使用剂量为 2050 U/kg，逐渐增加至510 U/(kg h)，若患者存在出血倾向及时停用。两组均连续治疗7 d。1.3观察指标与检测方法1.3.1炎症指标治疗前后分别抽取患者3 mL空腹静脉血，离心机3 000 r/min分离血清10 min。通过酶联免疫吸附法检测白介素-6(interleukin-6，IL-6)、降钙素原(procalcitonin，PCT)、肿瘤坏死因子-(tumor ne-crosis factor-，TNF-)，严格按照说明书进行检测。1.3.2肾功能治疗前后分别抽取患者5 mL空腹静脉血，离心机3 000 r/min分离血清10 min。双缩脲法测定血肌酐(creatinine，Cr)、尿素酶法测定尿素氮(blood urea nitrogen，BUN)以及全自动生化分析仪检测胆碱酯酶(choline esterase，CHE)，试剂盒均购自北京美康生物公司，严格按照说明书进行操作检测。1.3.3免疫功能治疗前后分别抽取患者3 mL空腹静脉血，离心机3 000 r/min分离血清10 min。美国贝克曼流式细胞仪检测CD3+、CD4+、CD8+，严格按照说明书检测。1.4统计学方法应用SPSS21.0软件进行数据统计分析。计量资料符合正态分布，以均数标准差(x-s)表示，组间比较采用t检验；计数资料比较采用2检验。以P0.05为差异有统计学意义。2结果2.1两组患