持续低效血液透析联合血液灌注对脓毒症终末期肾脏病患者肾功能、血清PCT、KIM-1水平及预后的影响  

Effects of continuous low-efficiency hemodialysis combined with blood perfusion on renal function,serum PCT,KIM-1 levels and prognosis of patients with end-stage renal disease in sepsis

作　　者：姜少利 闫国胜 李丽丽 JIANG Shao-li;YAN Guo-sheng;LI Li-li(Department of Nephrology(Blood Purification Room),Huanghe S&T College Affiliated Hospital,Zhengzhou 450000,Henan,CHINA;Blood Purification Center,Henan Provincial People's Hospital,Zhengzhou 450000,Henan,CHINA;Blood Purification Room,Zhengzhou Sixth People's Hospital,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]黄河科技学院附属医院肾内科(血液净化室),河南郑州450000 [2]河南省人民医院血液净化中心,河南郑州450000 [3]郑州市第六人民医院血液净化室,河南郑州450000

出　　处：《海南医学》2025年第3期332-336,共5页Hainan Medical Journal

基　　金：河南省科技发展计划项目(编号:192502315070)。

摘　　要：目的探讨持续低效血液透析联合血液灌注对脓毒症终末期肾脏病患者肾功能、血清降钙素原(PCT)、肾损伤分子-1(KIM-1)水平及预后的影响。方法选择2022年2月至2024年2月黄河科技学院附属医院接诊的80例脓毒症终末期肾病患者进行前瞻性研究,按照随机数表法分为观察组和对照组,各40例。对照组患者采用常规治疗联合持续低效血液透析治疗,观察组患者在对照组的基础上联合血液灌注治疗,两组患者均持续治疗28 d。治疗前及治疗7 d后,比较两组患者的平均动脉压(MAP)、心率(HR)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分;比较两组患者的血肌酐(SCr)、尿素氮(BUN)、尿量、估算的肾小球滤过率(eGFR);比较两组患者的血清PCT、KIM-1;比较两组患者的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)水平的变化;比较两组患者治疗期间不良反应发生率;治疗28 d后,比较两组患者的病死率。结果治疗前,两组患者的MAP、HR、APACHEⅡ评分比较差异无统计学意义(P>0.05);治疗7 d后,观察组患者MAP为(89.01±4.68)mmHg,明显高于对照组的(85.23±5.34)mmHg,HR、APACHEⅡ评分分别为(104.06±5.18)次/min、(18.02±2.31)分,均明显低于对照组的(109.33±6.12)次/min、(20.14±2.54)分,差异均有统计学意义(P<0.05)。治疗前,两组患者的SCr、BUN、尿量、eGFR比较差异无统计学意义(P>0.05);治疗7 d后,观察组SCr、BUN分别为(267.05±28.34)μmol/L、(18.67±2.32)mmol/L,均明显低于对照组的(302.56±31.84)μmol/L、(22.49±2.61)mmol/L,尿量、e GFR为(875.21±128.59)m L/24 h、(42.03±3.29)m L/(min·1.73 m2),明显高于对照组的(798.64±133.29)m L/24 h、(38.17±3.73)m L/(min·1.73 m2),差异均有统计学意义(P<0.05)。治疗前,两组患者的PCT、KIM-1水平比较差异无统计学意义(P>0.05);治疗7 d后,观察组患者血清PCT、KIM-1水平分别为(8.63±1.85)ng/mL、(17.49±2.01)ng/mL,均明显�Objective To investigate the effects of continuous low-efficiency hemodialysis combined with blood perfusion on renal function,serum procalcitonin(PCT)and renal injury molecular 1(KIM-1)levels and prognosis of patients with end-stage renal disease in sepsis.Methods A prospective study was conducted on 80 patients with sepsis end-stage renal disease admitted to Huanghe S&T College Affiliated Hospital from February 2022 to February 2024.The patients were randomly divided into an observation group and a control group,with 40 patients in each group.Patients in the control group received conventional treatment combined with continuous low-efficiency hemodialysis treatment,while those in the observation group received continuous low-efficiency hemodialysis combined with blood perfusion,continuously for 28 days.Before and after 7 days of treatment,the two groups were compared in the mean arterial pressure(MAP),heart rate(HR),and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scoring system;the levels of serum creatinine(SCr),blood urea nitrogen(BUN),urine output,and estimated glomerular filtration rate(eGFR);the serum PCT and KIM-1 levels;the changes in tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and high-sensitivity C-reactive protein(hs-CRP)levels;and the incidence of adverse reactions during treatment and the mortality rate after 28 days of treatment.Results Before treatment,there was no statistically significant difference in MAP,HR,and APACHEⅡscores between the two groups of patients(P>0.05).After 7 days of treatment,the MAP of the observation group was(89.01±4.68)mmHg,significantly higher than the control group's(85.23±5.34)mmHg;the HR and APACHEⅡscores were(104.06±5.18)beats/min and(18.02±2.31)points,respectively,which were significantly lower than the control group's(109.33±6.12)beats/min and(20.14±2.54)points;the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in SCr,BUN,urine output,and eGFR(P>0.05).After 7 da

关 键 词：脓毒症 终末期肾病 血液透析 血液灌注 肾功能 预后 

分 类 号：R692[医药卫生—泌尿科学]