连续性血液滤过对产后重症急性肾功能衰竭患者免疫反应和炎症反应的影响  

Effect of continuous venovenous hemofiltration on immune response and inflammatory response in postpartum patients with severe acute renal failure

作　　者：周莺莺 耿志安 

机构地区：[1]丽水市人民医院重症医学科,浙江丽水323000 [2]温州市第二人民医院重症医学科

出　　处：《中国妇幼保健》2024年第9期1570-1574,共5页Maternal and Child Health Care of China

基　　金：浙江省科技厅临床科研基金项目(2020C02030)。

摘　　要：目的 探讨连续性血液滤过(CVVH)对产后重症急性肾功能衰竭(ARF)患者免疫反应和炎症反应的影响。方法 选取2019年2月—2022年2月丽水市人民医院收治的80例产后重症ARF患者,随机分为对照组和观察组,每组各40例。对照组给予传统间歇性血液透析(IHD)治疗,观察组给予CVVH治疗。比较两组临床疗效,治疗前后的血液毒素指标[血清尿素氮(BUN)、血肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)]、细胞免疫反应指标(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值)、血清炎症反应指标[超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)]、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分及序贯器官衰竭评估(SOFA)评分。结果 观察组总有效率为90.00%,明显高于对照组的72.50%(χ^(2)=4.021,P<0.05)。治疗后,观察组BUN、 Scr、 β_(2)-MG水平分别为(13.87±4.19)mmol/L、(150.36±22.13)μmol/L、(2.14±0.62)mg/L,均明显低于对照组的(17.79±4.65)mmol/L、(279.38±32.54)μmol/L、(3.31±0.78)mg/L,差异均有统计学意义(t=3.961、20.736、7.427,均P<0.05)。治疗后,观察组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)比值分别为(58.82±5.00)%、(35.49±3.05)%、(1.34±0.25),明显高于对照组的(54.54±4.46)%、(33.64±3.00)%、(1.17±0.33),差异均有统计学意义(t=4.040、2.735、2.597,均P<0.05)。治疗后,观察组CD8^(+)为(26.56±3.12)%,明显低于对照组的(28.63±3.33)%,差异有统计学意义(t=2.869,P<0.05)。治疗后,观察组血清hs-CRP、TNF-α、IL-1β水平分别为(3.72±1.15)mg/L、(8.11±2.10)ng/L、(10.38±2.68)pg/ml,均明显低于对照组的(4.52±1.24)mg/L、(12.25±3.33)ng/L、(14.38±3.00)pg/ml,差异均有统计学意义(t=2.992、6.651、6.289,均P<0.05)。治疗后,观察组APACHEⅡ和SOFA评分分别为(5.75±2.63)分和(3.32±1.10)分,均明显低于对照组的(9.73±3.65)分和(6.50±1.23)分,差异均有统计学意义(t=5.595、12.188,均P<0.05)。观察组不良反应总发生率为12.Objective To explore the effect of continuous venovenous hemofiltration(CVVH) on immune response and inflammatory response in postpartum patients with severe acute renal failure(ARF).Methods A total of 80 postpartum patients with severe ARF admitted to Lishui City People's Hospital from February 2019 to February 2022 were randomly divided into control group(40 cases) and observation group(40 cases).The patients in control group were treated with traditional intermittent hemodialysis(IHD).The patients in observation group were treated with CVVH.The clinical efficacies of the two groups were compared.Blood toxin indexes [blood urea nitrogen(BUN), serum creatinine(Scr), and β_(2)-microglobulin(β_(2)-MG)], indexes of cellular immune response(CD3^(+), CD4^(+), CD8^(+), and CD4^(+)/CD8^(+) ratio), indexes of serum inflammatory response [hypersensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)], acute physiology and chronic healthy evaluation Ⅱ(APACHE Ⅱ) scores, and sequential organ failure assessment(SOFA) scores before and after treatment in the two groups were compared.Results The total effective rate of observation group was 90.00%, which was significantly higher than that of control group(72.50%)(χ^(2)=4.021, P<0.05).After treatment, the levels of BUN, Scr, and β_(2)-MG in observation group were(13.87±4.19) mmol/L,(150.36±22.13) μmol/L, and(2.14±0.62) mg/L, respectively, which were significantly lower than those in control group [(17.79±4.65) mmol/L,(279.38±32.54) μmol/L,(3.31±0.78) mg/L](t=3.961, 20.736, 7.427, P<0.05).After treatment, the levels of CD3^(+), CD4^(+), and CD4^(+)/CD8^(+) ratio in observation group were(58.82±5.00)%,(35.49±3.05)%, and(1.34±0.25), respectively, which were significantly higher than those in control group [(54.54±4.46)%,(33.64±3.00)%, and(1.17±0.33)](t=4.040, 2.735, 2.597,P<0.05).After treatment, CD8^(+) level in observation group was(26.56±3.12)%, which was significantly lower than that in control group [(28.63±3.33)%

关 键 词：连续性血液滤过 急性肾功能衰竭 免疫反应 炎症反应 

分 类 号：R692[医药卫生—泌尿科学]