肝素结合蛋白在血液灌流(HA380)联合连续性静脉-静脉血液滤过治疗脓毒症中变化及意义  

Change and significance of heparin-binding protein in hemoperfusion(HA380)combined with continuous veno-venous haemofiltration for sepsis

作　　者：刘威 孙小者 苏龙[2] LIU Wei;SUN Xiaozhe;SU Long(School of Clinical Medicine,Jining Medical University,Jining,Shandong 272013,China;Department of Critical Care Medicine,Jining First People's Hospital,Jining,Shandong 27201l,China)

机构地区：[1]济宁医学院临床医学院,山东济宁272013 [2]济宁市第一人民医院重症医学科,山东济宁272011

出　　处：《中华实用诊断与治疗杂志》2024年第10期973-979,共7页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的观察脓毒症患者行血液灌流(HP)(HA380)联合连续性静脉-静脉血液滤过(CVVH)治疗前、后血肝素结合蛋白(HBP)水平变化,探讨HBP在疗效评估中的意义。方法2022年9月—2024年2月济宁市第一人民医院诊治脓毒症患者92例,随机分为观察组和对照组各46例。对照组给予常规治疗,观察组在常规治疗基础上行HP(HA380)联合CVVH的连续性血液净化治疗72 h。治疗前、治疗72 h后记录序贯器官衰竭评估(SOFA)评分、急性生理学和慢性健康状况评估Ⅱ(APACHEⅡ)评分、平均动脉压(MAP)、氧合指数(OI),测定动脉血HBP、降钙素原(PCT)、C反应蛋白(CRP)、乳酸、白细胞介素(IL)-6、IL-8、IL-10水平,计算SOFA评分降低率、HBP水平降低率。采用Spearman相关法分析观察组、对照组治疗前、后血HBP水平与SOFA评分的相关性及血HBP水平降低率与SOFA评分降低率的相关性。结果治疗后观察组SOFA评分[(6.39±1.67)分]、APACHEⅡ评分[(11.48±1.81)分]及血HBP[176.38(154.99,192.27)μg/L]、PCT[32.07(28.84,36.40)μg/L]、CRP[125.36(112.87,144.48)mg/L]、乳酸[3.15(2.50,3.50)mmol/L]、IL-6[348.44(123.89,648.86)ng/L]、IL-8[133.47(77.47,248.04)ng/L]、IL-10[76.63(39.14,159.79)ng/L]水平均低于对照组[(9.11±2.11)分、(16.30±3.81)分、254.98(228.48,263.05)μg/L、61.74(48.62,65.67)μg/L、170.36(161.47,183.94)mg/L、3.80(3.30,4.53)mmol/L、456.00(252.35,1666.37)ng/L、186.90(115.77,498.07)ng/L、141.76(62.04,783.80)ng/L](t=6.854、7.757,Z=-8.262、-7.583、-6.833、-5.487、-3.350、-2.608、-2.475;P均<0.05),MAP[(84.25±2.25)mmHg]、OI[(265.19±12.85)mmHg]均高于对照组[(76.57±2.77)mmHg、(192.84±13.98)mmHg](t=-14.604,P<0.001;t=-25.844,P<0.001);2组治疗后SOFA评分、APACHEⅡ评分及血HBP、PCT、CRP、乳酸、IL-6、IL-8、IL-10水平均低于治疗前(t=30.231~56.887,Z=-6.805~-4.905,P均<0.05),MAP、OI均高于治疗前(t=-122.463~-44.527,P均<0.05);治疗前2组上述指标比较差异均无统计学意义(t=-1.748~0.387,Z=-1.91Objective To observe the changes of blood heparin-binding protein(HBP)after hemoperfusion(HA380)combined with continuous veno-venous haemodiafiltration(CVVH)in septic patients,and to explore the significance of HBP in assessing therapeutic effect.Methods Ninety-two septic patients were treated in Jining First People's Hospital from September 2022 to February 2024,and were randomly and equally divided into observation group and control group.Control group received conventional treatment,besides which observation group received continuous blood purification with hemoperfusion(HA380)combined with CVVH for 72 h.Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,mean arterial pressure,and oxygenation index were recorded before and 72 h after treatment.Arterial HBP,procalcitonin,C-reactive protein,lactate,interleukin(IL)-6,IL-8,and IL-10 levels were measured.The reduction rates of SOFA score and HBP level were calculated.Spearman's correlation method was used to analyze the correlation betwee n HBP level and SOFA score,and between HBP level reduction rate and SOFA score reduction rate before and after treatment in two groups.Results The scores of SOFA and APACHEⅡ,and the levels of HBP,procalcitonin,C-reactive protein,lactate,IL-6,IL-8 and IL-10 were lower after treatment in observation group[6.39±1.67,11.48±1.81,176.38(154.99,192.27)μg/L,32.07(28.84,36.40)μg/L,125.36(112.87.144.48)mg/L,3.15(2.50,3.50)mmol/L,348.44(123.89,648.86)ng/L,133.47(77.47,248.04)ng/L,76.63(39.14,159.79)ng/L]than those in control group[9.11±2.11,16.30±3.81,254.98(228.48,263.05)μg/L,61.74(48.62,65.67)μg/L,170.36(161.47,183.94)mg/L,3.80(3.30,4.53)mmol/L,456.00(252.35,1666-37)ng/L,186.90(115.77,498.07)ng/L,141.76(62.04,783.80)ng/L](t=6.854,t=7.757,Z=-8.262,Z=-7.583,Z=-6.833,Z=-5.487,Z=-3.350,Z=-2.608,Z=-2.475;all P values<0.05),and were lower in both groups after treatment than those before treatment(t=30.231-56.887,Z=-6.805 to-4.905;all P values<0.05).The mean arterial pressure

关 键 词：脓毒症 肝素结合蛋白 血液灌流 HA380 连续性静脉-静脉血液滤过 

分 类 号：R459.7[医药卫生—急诊医学]