持续性肾脏替代疗法对重症急性胰腺炎相关性肾损害的防治效果

目的观察持续性肾脏替代疗法(CRRT)对重症急性胰腺炎(SAP)相关性急性肾损伤(APAKI)的防治效果。方法选择禹州市人民医院和郑州大学第一附属医院确诊的86例SAP患者,随机分为CRRT组和对照组各43例,两组均常规SAP治疗,CRRT组加用CRRT治疗。检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、内毒素(ET)、血清尿素氮(BUN)、肌酐(SCr)、尿量、尿比重等,记录发生APAKI的时间、人次和严重程度。结果 CRRT组和对照组10 d内APAKI累计发生概率分别是32.6%和53.5%(Kaplan-Meier法),χ2=4.241,P=0.039。对照组APAKI偏向于较严重(Ⅲ期)的可能性是CRRT组的3.97倍(e1.311≈3.709 878),χ2=3.456,P=0.063。治疗后3、7 d CRRT组TNF-α、IL-6和ET较治疗前降低(P0.01);对照组各指标较治疗前升高(P0.01);组间比较差异有统计学意义(P0.01)。治疗后3、7 d对照组BUN和SCr有升高趋势(P0.05),CRRT组比治疗前降低(P0.05或0.01),组间比较差异有统计学意义(P0.01)。治疗后两组尿量增加(P0.05),以CRRT组增加更明显,与对照组相比差异有统计学意义(P0.01)。治疗后3、7d对照组尿比重标准差值小于CRRT组(P0.05)。结论 SAP患者肾功能损害明显,CRRT治疗能显著减少APAKI的发生率,减轻肾功能损害程度,清除炎症介质,改善患者的预后。

The Effect of Continuous Renal Replacement Therapy in Preventing Severe Acute Pancreatitis Associated Kidney Injury

Objective To observe the effect of continuous renal replacement therapy in preventing severe acute pancreatitis associated kidney injury（APAKI）.Methods 86 patients with severe acute pancreatitis in Yuzhou People’s Hospital and the First Affiliated Hospital of Zhengzhou University were randomized into two groups： the CRRT group and the control group.All patients were treated by routine SAP therapy,while the continuous renal replacement therapy was given to the CRRT group.TNF-α,interleukin-6,endotoxins,blood urea nitrogen,serum cremine,urine volume and urinary specific gravity were examined.The incidence of severe APAKI was recorded.Results Cumulative probability（Kaplan-Meier method） of APAKI was 32.6% in the CRRT group and 53.5% in the control group in 10 days（χ^2=4.241,P=0.039）.The severity of APAKI in control group was 3.97 times than in the CRRT group（e1.311≈3.709 878）（χ^2=3.456,P=0.063）.After 3 and 7 days treatment,the CRRT group showed that the 1eve1s of TNF-α,IL-6,endotoxins,blood urea nitrogen,and serum cremine were decreased,and urine volume,standard deviation of urinary specific gravity were significantly increased than those before treatment（P〈0.01） and also than those in control group（P〈0.05）.Conclusion Severe acute pancreatitis could cause renal injury.Continuous renal replacement therapy could reduce incidence of renal injury,attenuates severity of renal injury,and improve their prognosis.