连续性血液净化对重症脓毒症患者炎症及营养状态的影响

目的 探讨连续性肾脏替代治疗(CRRT)对重症脓毒症患者体内炎症与营养状态的影响,并分析其相关性. 方法 本研究为前瞻、对照性研究,选取铝例2004-2007年广州市第一人民医院ICU住院重症脓毒症患者进行随机分组.其中27例接受CRRT治疗,采用前稀释连续性静脉-静脉血液滤过(CVVH),21例患者仅接受常规支持治疗,所有患者均于治疗前、治疗1周及两周后分别抽血检测血浆肿瘤坏死因子(TNF-α)及C反应蛋白水平(CRP),并观察白蛋白、前白蛋白、转铁蛋白及胰岛素样生长因子(IGF-1)等营养指标的变化,分析各指标改变的相关性,同时比较两组患者生存率的差异.治疗前后用配对t检验(Paired-Sample t Test)及One-way ANOVA检验,相关性分析采用单因素相关分析和多因素逐步回归分析. 结果 270例患者接受CVVH治疗后血浆CRP及TNF-α水平明显下降(P<0.05),而白蛋白等营养指标水平显著上升(P<0.05),CRRT治疗组死亡率显著下降.患者前白蛋白、IGF-1水平与CRP、TNF-α水平及患者预后显著相关(P<0.05). 结论 CRRT治疗应用于重症脓毒症患者能有效的缓解炎症反应,改善患者营养状态,前白蛋白及IGF-1可能是反映重症脓毒症患者炎症和营养状态更敏感特异的指标.

Effects of continuous blood purification on inflammation and nutritional status in patients with sever sepsis

Objective To study the effect of continuous blood purification on inflammation and nutritional status in patients with sepsis, and to study relationship between inflammatory, malnutrition and illness. Method Forty-eight patients with severe sepsis were randomly divided into two groups: continuous renal replacement treat-ment (CRRT) group (n=27) and control group (n=21). The flowing biomarkers including albumin, preallbu-min, transfenin, insulin-like growth factor-1 (IGF-1), tumor necrosis factor (TNF-α) and C reactive protein (CRP) were determined before,and 1 week and 2 weeks after treatment. Results Compared with control group, levels of albumin, prealbumin and IGF-1 in treatment group increased significantly at 14 days after CRRT (P<0.05), and levels d CRP and TNF-α decreased significantly (P<0.05), resulted in increase in survival rate, shortened me-chanical ventilation time and decreased SOFA scores (P<0.05). The IGF-1 and prealbumin had a negative cor-relations with CRP and TNF-a in both groups (P<0.05). The survivors in both groups had significantly higher levels of IGF-1,prealbumin and TNF-α than the deads before trearment(P<0.05). Conclusions Continuous blood purification can effectively attenuate inflammation and improve nutritional status in patients with severe sep-sis.Maybe IGF-1 and prealbumin act as prognostic markers more sensitive in severe sepsis.