摘要
目的探讨连续性肾脏替代治疗(CRRT)脓毒症急性肾损伤(AKI)的疗效及对Toll样受体(TLRs)通路的影响。方法回顾性选取2016年9月至2020年9月在廊坊市人民医院接受治疗的脓毒症合并AKI的患者158例,根据患者及其家属接受CRRT治疗的意愿分为CRRT组(n=71)、对照组(n=87)。对照组患者接受液体复苏、抗感染等常规治疗,CRRT组患者在对照组基础上加入CRRT治疗。对比两组患者的尿量恢复时间、入住ICU时间、院内主要心血管事件(MACE)发生情况,分析治疗3 d后肾功能[血肌酐(SCr)、血尿素氮(BUN)、血尿酸(UA)]及炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平、TLRs通路相关指标水平的变化。结果CRRT组患者的尿量恢复时间、入住ICU时间为(8.74±1.03)、(9.63±1.52)d,短于对照组患者[(10.58±1.74)、(12.28±2.09)d],院内MACE发生率(8.45%)低于对照组患者(19.54%),差异均有统计学意义(P<0.05)。治疗3 d后,CRRT组患者的SCr、BUN、UA、TNF-α、IL-6、TLR-2、TLR-4、NF-κB水平为(171.20±20.47)μmol/L、(21.20±3.47)mmol/L、(463.84±59.23)μmol/L、(14.20±2.35)pg/mL、(11.32±2.18)pg/mL、0.59±0.08、0.41±0.09、0.43±0.09,低于对照组患者[(210.38±27.94)μmol/L、(28.41±4.20)mmol/L、(578.21±74.29)μmol/L、(18.17±2.11)pg/mL、(14.61±1.97)pg/mL、0.77±0.11、0.72±0.14、0.67±0.11],差异均有统计学意义(P<0.05)。结论CRRT可有效改善脓毒症合并AKI患者的病情,可能与其减弱TLRs通路激活后所致剧烈炎症反应相关。
Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)in septic acute kidney injury(AKI)and its effect on toll-like receptors(TLRs)pathway.Methods A total of 158 patients with sepsis complicated with AKI who received treatment in Langfang People's Hospital from September 2016 to September 2020 were divided into CRRT group(n=71)and control group(n=87)according to the willingness of patients and their families to receive CRRT treatment.Patients in control group received fluid resuscitation,anti-infection and other conventional treatments,patients in CRRT group received CRRT treatment on the basis of control group.Recovery time of urine volume,time of stay in ICU and occurrence of major in-hospital cardiovascular events(MACE)were compared between two groups were compared,atment effect of two groups was compared,changes of renal function[serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA)],inflammatory indexes[tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6)]and TLRs pathway related indexes were analyzed 3 days after treatment.Resluts The recovery time of urine output and ICU stay in CRRT group were(8.74±1.03)and(9.63±1.52)d,which were shorter than those in the control group[(10.58±1.74),(12.28±2.09)d],and the incidence of MACE in the hospital(8.45%)was lower thanthst in the control group(19.54%),the differences were statistically significant(P<0.05).After 3 days of treatment,the levels of SCr,BUN,UA,TNF-α,IL-6,TLR-2,TLR-4 and NF-κB in the CRRT group were(171.20±20.47)μmol/L,(21.20±3.47)mmol/L,(463.84±59.23)μmol/L,(14.20±2.35)pg/mL,(11.32±2.18)pg/mL,0.59±0.08,0.41±0.09 and 0.43±0.09,which were lower than those in the control group[(210.38±27.94)μmol/L,(28.41±4.20)mmol/L,(578.21±74.29)μmol/L,(18.17±2.11)pg/mL,(14.61±1.97)pg/mL,0.77±0.11,0.72±0.14,0.67±0.11],the differences were statistically significant(P<0.05).Conclusion CRRT can effectively improve the condition of patients with sepsis complicated with AKI,which may be related to the decrease of
作者
陈珊珊
岳英丽
刘东海
李海荣
CHEN Shan-shan;YUE Ying-li;LIU Dong-hai(Department of Nephrology,Langfang People's Hospital,Langfang Hebei 065000,China.;Department of Dermatology,Langfang People's Hospital,Langfang Hebei 065000,China.)
出处
《临床和实验医学杂志》
2021年第17期1838-1841,共4页
Journal of Clinical and Experimental Medicine
基金
河北省科技计划项目(编号:2018013138)。
