连续性血液净化与间歇性血液透析对脓毒症合并急性肾损伤患者RAAS系统指标和血清sTREM-1、HMGB1、TLR4的影响  

Effects of Continuous Blood Purification and Intermittent Hemodialysis on RAAS System Indexes and Serum sTREM-1,HMGB1 and TLR4 in Patients with Sepsis Combined with Acute Kidney Injury

作　　者：苏梅 王海霞 苏晓峰 张超 祁小宇 SU Mei;WANG Hai-xia;SU Xiao-feng;ZHANG Chao;QI Xiao-yu(Department ofCritical Care Medicine,The Fifth Medical Center of the General Hospital of the Peoples Liberation Army,Bejing,100071,China;Department of Respiratory and Critical Care Medicine,The Fifth Medical Center of the General Hospital of the Peoples Liberation Army,Bejing,100071,China;Department of Outpatient,Beijing Garrison Haidian 1Ith Rest and Rehabilitation Center,Beijing,100080,China;Institute of Basic Medicine,School of Basic Medicine,Chengde Medical College,Chengde,Hebei,067000,China;Department of Clinical Laboratory,The Fifth Medical Center of the General Hospital of the Peoples Liberation Army,Bejing,100071,China)

机构地区：[1]解放军总医院第五医学中心危重症医学科,北京100071 [2]解放军总医院第五医学中心呼吸与危重症医学科,北京100071 [3]北京卫戍区海淀第十一离休养所门诊部,北京100080 [4]承德医学院基础医学院基础医学研究所,河北承德067000 [5]解放军总医院第五医学中心检验科,北京100071

出　　处：《现代生物医学进展》2024年第17期3265-3268,共4页Progress in Modern Biomedicine

基　　金：河北省医学科学研究计划项目(20220408)。

摘　　要：目的:对比脓毒症合并急性肾损伤(AKI)患者分别经间歇性血液透析(IHD)、连续性血液净化(CBP)治疗后血清肾素-血管紧张素-醛固酮(RAAS)系统指标和血清高迁移率族蛋白1(HMGB1)、可溶性髓系细胞触发受体-1(sTREM-1)、Toll样受体4(TLR4)的变化情况。方法:选取2019年1月~2023年6月期间我院收治的107例脓毒症合并AKI患者。根据随机数字表法将患者分为间歇组(n=53,接受IHD治疗)和连续组(n=54,接受CBP治疗)。对比两组RAAS系统指标、血清sTREM-1、HMGB1、TLR4、肾功能、免疫功能指标。结果:治疗后,两组肾素活性(PRA)、醛固酮(ALD)、血管紧张素Ⅰ(AngI)、sTREM-1、HMGB1、TLR4、尿素氮(BUN)、血肌酐(Scr)下降,且连续组低于间歇组(P<0.05)。治疗后,两组CD8^(+)下降,且连续组低于间歇组;CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)升高,且连续组高于间歇组(P<0.05)。结论:与IHD治疗相比,CBP治疗脓毒症合并AKI,可进一步改善肾功能,提高免疫功能,调节RAAS系统指标和血清sTREM-1、HMGB1、TLR4水平。Objective:To compare the changes in serum renin angiotensin aldosterone(RAAS)system indicators and serum high mobility group protein 1(HMGB1),soluble myeloid cell trigger receptor-1(sTREM-1),and Toll like receptor-4(TLR4)levels in patients with sepsis complicated by acute kidney injury(AKI)after intermittent hemodialysis(IHD)and continuous blood purification(CBP)treatment.Methods:107 patients with sepsis combine with AKI admitted to our hospital from January 2019 to June 2023 were selected.Patients were divided into intermittent group(n=53,receiving IHD treatment)and continuous group(n=54,receiving CBP treatment)according to the random number table method.The RAAS system indexes,serum sTREM-1,HMGB1,TLR4,renal function and immune function indexes were compared between two groups.Results:After treatment,the renin activity(PRA),aldosterone(ALD),angiotensin I(AngI),sTREM-1,HMGB1,TLR4,urea nitrogen(BUN)and serum creatinine(Scr)in two groups decreased,and those in continuous group were lower than those in intermittent group(P<0.05).After treatment,CD8^(+)decreased in both groups,and continuous group was lower than than in intermittent group.CD3^(+),CD4^(+),CD4^(+)/CD8^(+)increased,and continuous group were higher than those in intermittent group(P<0.05).Conclusion:Compared with IHD treatment,CBP treatment of sepsis combine with AKI,which can further improve renal function,improve immune function,regulate RAAS system indexes and serum sTREM-1,HMGB1,TLR4 levels.

关 键 词：血液净化 血液透析 脓毒症 急性肾损伤 RAAS系统 STREM-1 HMGB1 TLR4 

分 类 号：R631.2[医药卫生—外科学] R459.5[医药卫生—临床医学]