连续性肾脏替代疗法对重症急性肾功能损伤患者的疗效及IL-6和TNF-α的影响
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摘要
目的探讨连续性肾脏替代疗法(CRRT)对重症急性肾功能损伤(AKI)患者的疗效及白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)的影响。方法回顾性分析2015年2月～2016年10月在北京市海淀医院重症医学科采用CRRT进行治疗的55例重症AKI患者的临床资料(研究组),并以同期采用间歇性血液透析(IHD)进行治疗的38例重症AKI患者为对照组。治疗3个月后,分析比较两组临床疗效及IL-6、TNF-α水平。结果治疗后,两组血清肌酐、血尿素氮水平均较治疗前降低,研究组血清肌酐、血尿素氮水平均明显低于对照组,差异有统计学意义(P <0.05)。治疗后,两组血生化指标均较治疗前有明显改善,研究组血生化指标改善情况明显优于对照组,差异有统计学意义(P <0.05)。研究组临床有效率、生存率分别为74.14%、87.27%,均明显高于对照组的57.89%、68.42%,差异均有统计学意义(P <0.05)。治疗后,两组患者IL-6、TNF-α水平均较治疗前明显下降(P <0.05),且研究组IL-6、TNF-α水平明显低于对照组,差异有统计学意义(P <0.05)。结论 CRRT治疗重症急性肾功能损伤患者疗效确切,可有效清除炎性因子,提高患者生存率,值得临床推广。
Objective To investigate the effects of continuous renal replacement therapy(CRRT) on clinical effect and IL-6, TNF-α of patients with severe acute kidney injury(AKI). Methods A retrospective analysis was conducted, including 55 cases with severe AKI treated by CRRT in the Department of Severe Medicine, Beijing Haidian Hospital from February 2015 to October 2016 as study group, and another 38 cases with severe AKI treated by intermittent hemodialysis(IHD) in the same period as control group. After 3 months of treatment, clinical efficacy and interlukin-6(IL-6), umor necrosis factor-alpha(TNF-α) levels of the two groups were analyzed and compared. Results After treatment, the levels of serum creatinine and blood urea nitrogen of the two groups were lower than those before treatment,and the indices in the study group were lower than those in the control group, the differences were statistically significant(P < 0.05). After treatment, levels of blood biochemical indices improved in the two groups, the improvement of blood biochemical indices in the study group were better than those in the control group, the differences were statistically significant(P < 0.05). The clinical efficacy rate and survival rate in the study group were 74.14%, 87.27% respectively,significantly higher than those in the control group(57.89%, 68.42%), the differences were statistically significant(P <0.05). After treatment, the levels of IL-6, TNF-α in the two groups were both lower than those before treatment, and the levels of the IL-6 and TNF-α of the study group were significantly lower than those in the control group(P < 0.05).Conclusion CRRT can be effective treatment for severe AKI, which can obviously reduce inflammatory factors and efficiently improve survival rate of the patients, and it is worth of clinical promotion.
Objective To investigate the effects of continuous renal replacement therapy(CRRT) on clinical effect and IL-6, TNF-α of patients with severe acute kidney injury(AKI). Methods A retrospective analysis was conducted, including 55 cases with severe AKI treated by CRRT in the Department of Severe Medicine, Beijing Haidian Hospital from February 2015 to October 2016 as study group, and another 38 cases with severe AKI treated by intermittent hemodialysis(IHD) in the same period as control group. After 3 months of treatment, clinical efficacy and interlukin-6(IL-6), umor necrosis factor-alpha(TNF-α) levels of the two groups were analyzed and compared. Results After treatment, the levels of serum creatinine and blood urea nitrogen of the two groups were lower than those before treatment,and the indices in the study group were lower than those in the control group, the differences were statistically significant(P < 0.05). After treatment, levels of blood biochemical indices improved in the two groups, the improvement of blood biochemical indices in the study group were better than those in the control group, the differences were statistically significant(P < 0.05). The clinical efficacy rate and survival rate in the study group were 74.14%, 87.27% respectively,significantly higher than those in the control group(57.89%, 68.42%), the differences were statistically significant(P <0.05). After treatment, the levels of IL-6, TNF-α in the two groups were both lower than those before treatment, and the levels of the IL-6 and TNF-α of the study group were significantly lower than those in the control group(P < 0.05).Conclusion CRRT can be effective treatment for severe AKI, which can obviously reduce inflammatory factors and efficiently improve survival rate of the patients, and it is worth of clinical promotion.
引文
[1]杨文超,刘馨侠,王岩,等.连续性肾脏替代疗法在重症医学科中的合理应用评价[J].中国药学杂志,2016,51(11):935-941.
[2]杨晓燕,梅劲超.连续性肾脏替代疗法在感染性休克致急性肾功能衰竭中的应用[J].华南国防医学杂志,2014,28(6):601-602.
[3]刘晨溪,王强.危重症患者急性肾损伤的肾脏替代治疗进展[J].中国全科医学,2016,19(4):489-492.
[4] Bagshaw SM,Wald R. Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury[J]. Kidney Int,2017,91(5):1022-1032.
[5]王海燕.肾脏病学[M].3版.北京:人民卫生出版社,2008:940.
[6]汤星星,杨勇.急性肾功能损伤:NICE指南[J].英国医学杂志:中文版,2013,16(6):374-378.
[7]王娜,李培兰.急诊重症监护室急性肾功能损伤患者的临床特征及预后分析[J].临床荟萃,2018,33(4):319-322,328.
[8] Shaw AR,Mueller BA. Antibiotic Dosing in Continuous Renal Replacement Therapy[J]. Adv Chronic Kidney Dis,2017,24(4):219-227.
[9] Kovesdy CP,Naseer A,Sumida K,et al. Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy[J]. Kidney Int Rep,2018,3(3):602-609.
[10]刘强,许琳.连续性肾脏替代疗法与间歇性血液透析治疗重症急性肾功能衰竭的临床效果对比[J].华西医学,2017,32(3):392-394.
[11]季大玺,吴丛业.肾脏替代治疗在急性肾损伤应用中的争议和共识[J].医学研究生学报,2015,28(9):897-903.
[12]贺学宇,潘丽,汪蓉蓉,等.两种连续肾脏替代治疗在肝移植术后急性肾功能衰竭中的应用效果[J].武汉大学学报:医学版,2017,38(6):920-922.
[13]王星利.连续性肾脏替代治疗对重症急性肾功能衰竭患者疗效及肾功能的影响[J].中医临床研究,2017,9(13):132-133.
[14]李少华,秦学祥,郑晨,等.AKIN分期对CRRT治疗AKI重症患者预后的影响[J].中国医药科学,2018,8(1):227-229,236.
[15] Pertica N,Cicciarella L,Carraro A,et al. Safety and Efficacy of Citrate Anticoagulation for Continuous Renal Replacement Therapy for Acute Kidney Injury After Liver Transplantation:A Single-Center Experience[J].Transplant Proc,2017,49(4):674-676.
[16] Zhang L,Yang J,Eastwood GM,et al. Extended daily dialysis versus continuous renal replacement therapy for acute kidney injury:a meta-analysis[J]. Am J Kidney Dis,2015,66(2):322-330.
[17]牟志芳,董跃福,谢永鹏,等.连续肾替代抢救重症肾功能衰竭伴多器官衰竭40例临床研究[J].医药论坛杂志,2013,34(10):61-62.
[18] Heung M,Yessayan L. Renal replacement therapy in acute kidney injury:controversies and consensus[J]. Crit Care Clin,2017,33(2):365-378.
[19] Connor MJ Jr,Karakala N. Continuous renal replacement therapy:reviewing current best practice to provide highquality extracorporeal therapy to critically ill patients,advances in chronic kidney disease[J]. Adv Chronic Kidney Dis,2017,24(4):213-218.
[20]陆煜,张克娜,谭位华.连续低效每日血液透析滤过联合血液灌流治疗脓毒症急性肾损伤的临床疗效研究[J].中国全科医学,2014,17(24):2810-2813.
[21]黄健平.连续性肾替代治疗在脓毒症相关性急性肾损伤中的应用[J].中国当代医药,2016,23(1):74-76.
[22] Yessayan L,Yee J,Frinak S,et al. Continuous Renal Replacement Therapy for the Management of Acid-Base and Electrolyte Imbalances in Acute Kidney Injury[J].Adv Chronic Kidney Dis,2016,23(2):203-210.
[2]杨晓燕,梅劲超.连续性肾脏替代疗法在感染性休克致急性肾功能衰竭中的应用[J].华南国防医学杂志,2014,28(6):601-602.
[3]刘晨溪,王强.危重症患者急性肾损伤的肾脏替代治疗进展[J].中国全科医学,2016,19(4):489-492.
[4] Bagshaw SM,Wald R. Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury[J]. Kidney Int,2017,91(5):1022-1032.
[5]王海燕.肾脏病学[M].3版.北京:人民卫生出版社,2008:940.
[6]汤星星,杨勇.急性肾功能损伤:NICE指南[J].英国医学杂志:中文版,2013,16(6):374-378.
[7]王娜,李培兰.急诊重症监护室急性肾功能损伤患者的临床特征及预后分析[J].临床荟萃,2018,33(4):319-322,328.
[8] Shaw AR,Mueller BA. Antibiotic Dosing in Continuous Renal Replacement Therapy[J]. Adv Chronic Kidney Dis,2017,24(4):219-227.
[9] Kovesdy CP,Naseer A,Sumida K,et al. Abrupt Decline in Kidney Function Precipitating Initiation of Chronic Renal Replacement Therapy[J]. Kidney Int Rep,2018,3(3):602-609.
[10]刘强,许琳.连续性肾脏替代疗法与间歇性血液透析治疗重症急性肾功能衰竭的临床效果对比[J].华西医学,2017,32(3):392-394.
[11]季大玺,吴丛业.肾脏替代治疗在急性肾损伤应用中的争议和共识[J].医学研究生学报,2015,28(9):897-903.
[12]贺学宇,潘丽,汪蓉蓉,等.两种连续肾脏替代治疗在肝移植术后急性肾功能衰竭中的应用效果[J].武汉大学学报:医学版,2017,38(6):920-922.
[13]王星利.连续性肾脏替代治疗对重症急性肾功能衰竭患者疗效及肾功能的影响[J].中医临床研究,2017,9(13):132-133.
[14]李少华,秦学祥,郑晨,等.AKIN分期对CRRT治疗AKI重症患者预后的影响[J].中国医药科学,2018,8(1):227-229,236.
[15] Pertica N,Cicciarella L,Carraro A,et al. Safety and Efficacy of Citrate Anticoagulation for Continuous Renal Replacement Therapy for Acute Kidney Injury After Liver Transplantation:A Single-Center Experience[J].Transplant Proc,2017,49(4):674-676.
[16] Zhang L,Yang J,Eastwood GM,et al. Extended daily dialysis versus continuous renal replacement therapy for acute kidney injury:a meta-analysis[J]. Am J Kidney Dis,2015,66(2):322-330.
[17]牟志芳,董跃福,谢永鹏,等.连续肾替代抢救重症肾功能衰竭伴多器官衰竭40例临床研究[J].医药论坛杂志,2013,34(10):61-62.
[18] Heung M,Yessayan L. Renal replacement therapy in acute kidney injury:controversies and consensus[J]. Crit Care Clin,2017,33(2):365-378.
[19] Connor MJ Jr,Karakala N. Continuous renal replacement therapy:reviewing current best practice to provide highquality extracorporeal therapy to critically ill patients,advances in chronic kidney disease[J]. Adv Chronic Kidney Dis,2017,24(4):213-218.
[20]陆煜,张克娜,谭位华.连续低效每日血液透析滤过联合血液灌流治疗脓毒症急性肾损伤的临床疗效研究[J].中国全科医学,2014,17(24):2810-2813.
[21]黄健平.连续性肾替代治疗在脓毒症相关性急性肾损伤中的应用[J].中国当代医药,2016,23(1):74-76.
[22] Yessayan L,Yee J,Frinak S,et al. Continuous Renal Replacement Therapy for the Management of Acid-Base and Electrolyte Imbalances in Acute Kidney Injury[J].Adv Chronic Kidney Dis,2016,23(2):203-210.