摘要
目的:探讨组合式血液净化治疗对脓毒症患者炎症因子水平和临床预后的影响。方法:选取2020年12月至2021年8月新疆医科大学第一附属医院收治的28例脓毒症并进行血液净化治疗的患者为研究对象，采用随机分层化法将所有患者分为oXiris组（10例）、HA380组（7例）和oXiris + HA380组（11例）。oXiris组采用oXiris滤器行连续性静脉-静脉血液透析滤过（CVVHDF）血液净化治疗模式；HA380组采用ST100滤器联合HA380血液灌流器行CVVHDF血液吸附治疗模式；oXiris + HA380组采用oXiris滤器联合HA380血液灌流器行CVVHDF血液吸附治疗模式。于连续性肾脏替代疗法（CRRT）治疗0、2、4、6、12、24、48 h后，记录所有患者的血清炎症因子指标白细胞介素6（IL-6）、降钙素原（PCT）、高迁移率族蛋白B1（HMGB1）和干扰素γ（IFN-γ）。于治疗0、24、48 h后，记录患者序贯器官衰竭估计（SOFA）评分和急性病生理学和长期健康评价Ⅱ（APACHEⅡ）评分。同时，随访28 d，比较3组患者的生存情况。结果:3组患者各时间点PCT（F = 18.507，P<0.001）、HMGB1（F = 3.831，P = 0.035）、IFN-γ（F = 5.549，P = 0.010）水平比较，差异均有统计学意义，而3组患者各时间点IL-6、SOFA评分及APACHEⅡ评分比较，差异均无统计学意义（F = 0.628、0.489、0.960，P = 0.542、0.621、0.397）。进一步两两比较发现，oXiris + HA380组患者的PCT水平治疗48 h后较治疗开始时显著下降，但与同期HA380组比较仍较高（P均<0.05）；oXiris + HA380组的HMGB1、IFN-γ水平在治疗48 h后均显著低于HA380组（P均<0.05），但与oXiris组比较差异均无统计学意义（P均>0.05）。随访28 d后，oXiris组患者存活6例，HA380组患者存活4例，oXiris + HA380组患者存活5例，3组患者生存情况比较差异无统计学意义（χ2 = 0.493，P = 0.781）。结论:oXiris联合HA380的组合式血液净化在一定程度上可以清除脓毒症患者血清中的炎症因子，但对预后影响不显著。
Abstract
Objective:To explore the effect of combined blood purification on the levels of inflammatory cytokines and clinical prognosis in patients with sepsis.Methods:From December 2020 to August 2021, 28 patients with sepsis undergoing blood purification in the First Affiliated Hospital of Xinjiang Medical University were randomly divided into three groups: oXiris group (10 cases), HA380 group (7 cases) and oXiris + HA380 group (11 cases) by random stratification. The oXiris group was treated with continuous veno-venous hemodiafiltration (CVVHDF) with the oXiris filter, the HA380 group was treated with CVVHDF blood adsorption by the ST100 filter combined with HA380 hemoperfusion, and the oXiris + HA380 group was treated with CVVHDF blood adsorption by the oXiris filter combined with HA380 hemoperfusion. The inflammatory cytokine indexes of interleukin-6 (IL-6), procalcitonin (PCT), high mobility group protein 1 (HMGB1) and interferon-gamma (IFN-γ) were recorded at 0, 2, 4, 6, 12, 24 and 48 h after continuous renal replacement therapy (CRRT) treatment respectively. The sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were recorded at 0, 24 and 48 h after CRRT treatment. At the same time, the survival status was followed up for 28 days.Results:The levels of PCT (F = 18.507, P < 0.001), HMGB1 (F = 3.831, P = 0.035) and IFN-γ (F = 5.549, P = 0.010) among the three groups at each time point showed significant differences. However, there were no significant differences in IL-6, SOFA and APACHEⅡ scores among the three groups at each time point (F = 0.628, 0.489, 0.960; P = 0.542, 0.621, 0.397). Further pairwise comparison found that the PCT level in the oXiris + HA380 group decreased significantly after 48 h of treatment compared with the beginning of treatment, but it was still higher than that in the HA380 group at the same time (both P < 0.05). The levels of HMGB1 and IFN-γ in the oXiris + HA380 group were much lower than those in the HA380 group after 48 h of treatment (both P < 0.05), but the difference was not statistically significant compared with the oXiris group at the same time (both P > 0.05). After 28 days of follow-up, six patients survived in the oXiris group, four patients survived in the HA380 group, and five patients survived in the oXiris + HA380 group. There was no statistically significant difference in survival among the three groups (χ2 = 0.493, P = 0.781).Conclusion:oXiris combined with HA380 hemoperfusion can remove inflammatory cytokines in the serum of patients with sepsis to a certain extent, but it has no significant effect onprognosis.
万方数据