HP+CVVH对重症急性胰腺炎并急性肾损伤患者血管内皮功能、肾小管功能的影响  

Effect of HP+CVVH on vascular endothelial function and renal tubular function in patients with severe acute pancreatitis and acute renal injury

作　　者：温福铭[1] 王曼 李乐[2] WEN Fu-ming;WANG Man;LI Le(Department of Emergency,Guigang City People's Hospital,Guigang 537100,China)

机构地区：[1]贵港市人民医院急诊科,537100 [2]贵港市人民医院重症医学科,537100

出　　处：《中国现代药物应用》2024年第8期33-37,共5页Chinese Journal of Modern Drug Application

基　　金：贵港市自筹经费科研项目(项目编号:贵科攻2100016)。

摘　　要：目的探讨血液灌流(HP)+连续性静脉-静脉血液滤过(CVVH)对重症急性胰腺炎并急性肾损伤患者血管内皮功能、肾小管功能的影响。方法118例重症急性胰腺炎并急性肾损伤患者,按治疗方法的不同分为观察组(68例)和对照组(50例)。对照组应用HP治疗,观察组应用HP+CVVH治疗。比较两组治疗情况、血管内皮功能指标[内皮素-1(ET-1)、血管内皮生长因子(VEGF)及血管性假血友病因子相关抗原(vWF:Ag)]、肾小管功能指标[尿视黄醇结合蛋白(RBP)、尿N-乙酰-β-D氨基葡萄糖苷酶(UNAG)]、血清炎症因子[C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)]。结果观察组病死率1.47%(1/68)低于对照组的8.00%(4/50),但差异无统计学意义(P>0.05);观察组腹痛消失时间(2.67±0.51)d、腹膜刺激征消失时间(3.14±0.65)d、住院时间(15.41±2.16)d短于对照组的(3.91±0.68)、(4.82±0.71)、(20.82±3.59)d(P<0.05)。治疗后,两组患者ET-1、vWF:Ag、VEGF低于本组治疗前,且观察组ET-1(32.10±3.08)pg/ml、vWF:Ag(121.42±18.75)%、VEGF(134.68±28.79)pg/ml低于对照组的(40.78±3.18)pg/ml、(146.68±20.74)%、(162.47±41.25)pg/ml(P<0.05)。治疗后,两组尿RBP、UNAG水平低于本组治疗前,且观察组尿RBP(0.71±0.46)μg/ml、尿UNAG(1.01±0.52)U/g·Cr低于对照组的(1.62±0.51)μg/ml、(1.46±0.55)U/g·Cr(P<0.05)。治疗后,两组患者血清CRP、TNF-α、IL-2水平低于治疗前,且观察组血清CRP(8.51±1.23)mg/L、TNF-α(2.18±0.45)pg/ml、IL-2(6.53±1.08)pg/ml低于对照组的(13.48±2.58)mg/L、(3.06±0.52)pg/ml、(10.74±1.16)pg/ml(P<0.05)。结论HP+CVVH治疗重症急性胰腺炎并急性肾损伤患者取得较好效果,可改善患者血管内皮功能及肾小管功能,降低机体炎症反应,促进患者尽快恢复,值得应用。Objective To explore the effect of hemoperfusion(HP)+continuous veno-venous hemofiltration(CVVH)on vascular endothelial function and renal tubular function in patients with severe acute pancreatitis and acute renal injury.Methods 118 patients with severe acute pancreatitis and acute renal injury were selected and divided into an observation group(68 cases)and a control group(50 cases)according to different treatment methods.The control group was treated with HP,and the observation group was treated with HP+CVVH.Both groups were compared in terms of treatment,vascular endothelial function indicators[endothelin-1(ET-1),vascular endothelial growth factor(VEGF),and von Willebrand factor antigen(vWF:Ag)],renal tubular function indicators[urinary retinol binding protein(RBP),urinary N-Acetyl-β-d-glucosaminidase(UNAG)],and serum inflammatory factors[C-reactive protein(CRP),interleukin-2(IL-2),tumor necrosis factor-α(TNF-α)].Results The fatality rate of the observation group was 1.47%(1/68),which was lower than 8.00%(4/50)of the control group,but the difference was not statistically significant(P>0.05).In the observation group,the disappearance time of abdominal pain was(2.67±0.51)d,the disappearance time of peritoneal irritation sign was(3.14±0.65)d and the hospitalization time was(15.41±2.16)d,which were shorter than(3.91±0.68),(4.82±0.71)and(20.82±3.59)d in the control group(P<0.05).After treatment,ET-1,vWF:Ag and VEGF in both groups were lower than those before treatment;the observation group had ET-1 of(32.10±3.08)pg/ml,vWF:Ag of(121.42±18.75)%and VEGF of(134.68±28.79)pg/ml,which were lower than(40.78±3.18)pg/ml,(146.68±20.74)%and(162.47±41.25)pg/ml in the control group(P<0.05).After treatment,the urinary RBP and UNAG levels in both groups were lower than those before treatment;the observation group had urinary RBP of(0.71±0.46)μg/ml and UNAG of(1.01±0.52)U/g·Cr,which were lower than(1.62±0.51)μg/ml and(1.46±0.55)U/g·Cr in the control group(P<0.05).After treatment,the serum levels of CRP,TNF-�

关 键 词：急性胰腺炎 急性肾损伤 血液灌流 连续性静脉-静脉血液滤过 

分 类 号：R576[医药卫生—消化系统] R692[医药卫生—内科学]