CRRT对重症急性胰腺炎患者IL-1、TNF-a和CRP的影响

目的:持续性肾脏替代治疗(CRRT)应用于重症急性胰腺炎(SAP)患者,通过测定不同时间点患者血浆中白细胞介素-1(IL-1)、肿瘤坏死因子-a(TNF-a)及C反应蛋白(CRP)量的变化,对CRRT的治疗效果作进一步的探讨。方法:重症急性胰腺炎患者43例,随机分为治疗组23例与对照组20例,治疗组同时接受血液净化及常规治疗,对照组仅行常规治疗。观察及比较两组患者治疗0、8、24、48、72 h血浆中IL-1、TNF-a、CRP含量变化;记录两组患者住ICU天数、病死率;两组患者治疗前后急性生理和慢性健康状况评分Ⅱ(APACHE-Ⅱ)评分情况。结果:治疗组在ICU总住院时间明显短于对照组,病死率低于对照组,差异有统计学意义(P<0.05)。治疗组24 h、48 h、72 hAPACHE-Ⅱ评分较治疗前明显下降,以72 h最显著,差异有统计学意义(P<0.05)。治疗组经治疗后各时间点血浆中IL-1、TNF-a及CRP均较治疗前明显下降,同时明显低于同时间点的对照组,差异有统计学意义(P<0.05)。结论:CRRT可早期纠正SAP引起的器官功能障碍,改善全身状况,能有效防止多器官衰竭的发生,从而降低死亡率,提高患者的生存率。

Effects of Continuous Renal Replacement Therapy on Serum Levels of IL-1,TNF-a,and CRP in Patients with Severe Acute Pancreatitis

Objective: To investigate the effects of continuous renal replacement therapy(CRRT) on the serum levels of interleukin-1(IL-1),tumor necrosis factor(TNF-a) and c-reactive protein(CRP) in patients with severe acute pancreatitis(SAP),and to explore the pathogenesis of SAP.Methods: Forty-three SAP patients hospitalized in intensive care unit(ICU) from March 2009 to December 2010 were randomly divided into treatment group(n=23) in which patients received conventional treatment and CRRT,and control group(n=20) in which patients received conventional treatment only.Plasma levels of TNF-a,IL-1,and CRP in 0,8,24,48,72 hours after treatment were observed and compared between the two groups.The hospitalizing days and fatality rates were recorded,and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores were also recorded before and after treatment.Results: After treatment,hospitalizing days and fatality rate of treatment group were significantly lower than those of control group(P<0.05).The APACHE Ⅱ scores in treatment group in 24 h,48 h and especially in 72 h after treatment were significantly lower than those in control group(P<0.05).The Plasma levels of TNF-a,IL-1,and CRP were remarkably lower than those before treatment and than those of control group at the same time point(P<0.05);Conclusions: CRRT can correct multiple organ dysfunction induced by SAP,prevent the occurrence of multi-organ failure,reduce mortality and increase survival rate of patients with SAP.