连续性肾脏替代治疗对多器官功能障碍综合征患者血清炎症因子及预后的影响

目的研究连续性肾脏替代治疗（CRRT）对多器官功能障碍综合征（MODS）患者血清炎症介质清除及预后的影响。方法选取我院30例MODS患者，行CRRT治疗，每次治疗时间不低于24小时，观察生命体征变化，检测生化指标，计算急性生理学及慢性健康状况评分II（APACHEII）等，并分别于治疗开始时（O小时）和治疗后3小时、6小时、12小时、24小时取血检测肿瘤坏死因子α（TNF-α）、白细胞介素1β（IL-1β）、白细胞介素4（IL-4）、白细胞介素6（IL-6）、白细胞介素10（IL-10）。结果14天存活19例（存活率63．3％），28天存活17例（存活率56．7％）。治疗6小时后患者电解质和酸碱平衡于恢复正常。IL-1β、IL-4、IL-10治疗前后差异无统计学意义（均P〉0．05）；TNF-α、IL-6、IL-10在12小时浓度升高达峰值（887．88±975．46）ng／L，（132．01±118．14）ng／L，（167．01±161．66）ng／L]，与治疗前（462．24±331．03）ng／L，（106．39±90．82ng／L，（124．51±118．39ng／L]比较差异具有统计学意义。治疗后死亡组IL-6高于存活组，（145．45±14．28）ng／vs（106．03±10．86）ng／L（P〈0．05）；死亡组IL-10低于存活组，（94．93±16．09）ng／Lvs（143．06±12．24）ng／L（均P〈0．05）。结论CRRT可以使患者机体内环境得到纠正，但MODS患者外周血炎症介质浓度治疗前后差异无统计学意义。IL-6、IL-10水平可成为患者临床转归的预测指标。

Effects of continuous renal replacement therapy on patients of multiple organ dysfunction syndrome in removing inflammatory mediators

Objective To evaluate effects of continuous renal replacement therapy （CRRT） on patients of multiple organ dysfunction syndrome in removing inflammatory mediators. Methods Thirty patients with MODS were enrolled. All the patients underwent CRRT for at least 24 hours. IL-1β, IL-4, IL-6, IL-10, TNF-α levels were measured at the beginning and 3,6,12,24 hours after initiation of CRRT. Results Nineteen patients survived after 14 days and 17 patients survived after 28 days during therapy. The clinical oxygenation and hemodynamics were improved after 6 hours. Among these inflammatory mediators, the level of TNF-α, IL-6, IL-10 rose gradually from beginning （462.24±331.03） ng/L,（106.39±90.82） ng/L, （124.51±118.39） ng/L,and came to peak at 12 hours （887.88±975.46） ng/L,（132.01 ±118.14） ng/L, （167.01±161.66） ng/L, and the level of IL-1β, IL-4 decreased from initiation of CRRT,but there was no significant difference between beginning and the end of CRRT. The level of IL-6 in the death group was significantly higher than that in the survival group, （145.45±14.28） ng/L vs （106.03±10.86） ng/L（ P〈0.05 ）, and the level of IL-10 in the death group was significantly lower than that in the survival group, （94.93 ±16.09） ng/L vs （143.06±12.24） ng/L （both P〈0.05）. Conclusion Clinical oxygenation and hemodynamics situation can be improved by CRRT,but there were no significant different levels of inflammatory mediators between initiation and the end of CRRT. IL-6 and IL-10 can be used as predieators for outcomes of MODS patients.