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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (04) : 272 -278. doi: 10.3877/cma.j.issn.1674-6880.2023.04.002

论著

组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响
韩媛媛, 热孜亚·萨贝提, 冒智捷, 穆福娜依·艾尔肯, 陆晨, 桑晓红, 阿尔曼·木拉提, 张丽†()   
  1. 830054　乌鲁木齐，新疆医科大学第一附属医院肾脏病中心
    830054　乌鲁木齐，新疆医科大学第一临床医学院
  • 收稿日期:2023-01-21 出版日期:2023-08-31
  • 通信作者: 张丽
  • 基金资助:
    国家自然科学基金项目(81960145)

Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis

Yuanyuan Han, Sabeiti Reziya, Zhijie Mao, Aierken Mufunayi, Chen Lu, Xiaohong Sang, Mulati Aerman, Li Zhang†()   

  1. Department of Nephrology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    The First Clinical College of Xinjiang Medical University, Urumqi 830054, China
  • Received:2023-01-21 Published:2023-08-31
  • Corresponding author: Li Zhang
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引用本文：

韩媛媛, 热孜亚·萨贝提, 冒智捷, 穆福娜依·艾尔肯, 陆晨, 桑晓红, 阿尔曼·木拉提, 张丽. 组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 272-278.

Yuanyuan Han, Sabeiti Reziya, Zhijie Mao, Aierken Mufunayi, Chen Lu, Xiaohong Sang, Mulati Aerman, Li Zhang. Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 272-278.

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。

关键词: 脓毒症, 血液净化, 连续性肾脏替代治疗, 炎症因子, 预后
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.

Key words: Sepsis, Blood purification, Continuous renal replacement therapy, Inflammatory cytokines, Prognosis
表1 3组脓毒症患者基本临床资料的比较
组别 例数 年龄（岁， ± s） 男/女（例） 感染情况（例） 合并疾病（例）
肺部感染 腹腔感染 泌尿系统感染 软组织感染 高血压 糖尿病 慢性肾脏疾病 肝功能不全
oXiris组 10 58 ± 11 8/2 7 4 2 2 2 3 3 2
HA380组 7 60 ± 29 4/3 6 4 1 1 4 2 5 1
oXiris + HA380组 11 61 ± 20 9/2 8 9 5 3 2 6 4 6
F/χ2值   0.110 1.597 0.592 3.980 2.596 0.447 3.742 1.722 3.198 4.231
P值   0.909 0.450 0.744 0.143 0.273 0.800 0.154 0.412 0.202 0.121
组别 例数 并发症（例） 病原体类型（例） 28 d生存
呼吸衰竭 心力衰竭 急性肝损伤 急性肾损伤 电解质紊乱 脓毒性休克 革兰阴性菌 革兰阳性菌 真菌
oXiris组 10 8 6 7 10 2 6 7 2 5 6
HA380组 7 2 2 4 4 2 2 2 1 2 4
oXiris + HA380组 11 5 4 8 9 4 6 6 1 3 5
F/χ2值   4.859 1.973 0.590 5.157 0.687 1.777 2.848 0.509 1.386 0.493
P值   0.088 0.373 0.775 0.076 0.709 0.411 0.241 0.775 0.500 0.781
表2 3组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）
组别 例数 IL-6（ng/L） PCT（μg/L） HMGBI（ng/L） IFN-γ（ng/L） SOFA评分（分） APACHEⅡ评分（分）
oXiris组              
0 h 10 477 ± 268 36.0 ± 22.3 1 044 ± 1 014 20.5 ± 3.2 14 ± 5 23 ± 7
2 h 10 396 ± 221 25.2 ± 18.0 535 ± 318 25.6 ± 12.2 - -
4 h 10 410 ± 313 29.6 ± 15.5 902 ± 503 23.0 ± 12.2 - -
6 h 10 414 ± 288 37.2 ± 17.4 1 201 ± 489e 12.5 ± 1.8deh - -
12 h 10 338 ± 179 44.5 ± 27.5 1 104 ± 879e 13.8 ± 2.8deh - -
24 h 10 334 ± 190 31.9 ± 11.2 1 301 ± 897e 15.0 ± 3.0 14 ± 4 19 ± 6
48 h 10 311 ± 214 23.1 ± 9.2a 591 ± 180afg 14.0 ± 2.0deh 12 ± 5 17 ± 5
HA380组              
0 h 7 412 ± 229 5.7 ± 2.8b 902 ± 427 52.5 ± 39.5b 12 ± 4 26 ± 6
2 h 7 383 ± 290 5.2 ± 1.9b 702 ± 432 26.3 ± 19.0d - -
4 h 7 523 ± 345 5.8 ± 1.2b 930 ± 523 25.0 ± 17.0d - -
6 h 7 454 ± 340 6.0 ± 2.5b 770 ± 325 26.0 ± 11.5bd - -
12 h 7 460 ± 236 7.9 ± 3.0b 641 ± 240 20.4 ± 5.8bd - -
24 h 7 489 ± 218 8.6 ± 7.7b 738 ± 277 22.0 ± 6.8bd 11 ± 4 23 ± 6
48 h 7 485 ± 286 7.7 ± 7.6b 748 ± 209 20.8 ± 7.6bd 10 ± 4 21 ± 5
oXiris + HA380组              
0 h 11 655 ± 241 41.4 ± 17.4c 675 ± 281 27.7 ± 23.5c 13 ± 5 22 ± 6
2 h 11 482 ± 337 38.0 ± 21.0c 581 ± 375 17.1 ± 10.0d - -
4 h 11 346 ± 281 30.3 ± 25.2c 524 ± 309 15.2 ± 8.0d - -
6 h 11 412 ± 199 34.6 ± 24.2c 575 ± 421b 13.8 ± 3.8cd - -
12 h 11 277 ± 139 23.9 ± 14.0c 614 ± 150b 10.7 ± 4.1cd - -
24 h 11 290 ± 181 27.3 ± 18.4c 516 ± 266b 11.7 ± 5.8cd 12 ± 4 19 ± 7
48 h 11 324 ± 238 19.5 ± 11.1cd 445 ± 134c 12.2 ± 5.4cd 11 ± 4 18 ± 6
F值   0.628 18.507 3.831 5.549 0.489 0.960
P值   0.542 <0.001 0.035 0.010 0.621 0.397
表3 生存组与死亡组脓毒症患者血清炎症因子水平、SOFA评分及APACHEⅡ评分比较（ ± s）
组别 例数 IL-6（ng/L） PCT（μg/L） HMGBI（ng/L） IFN-γ（ng/L） SOFA评分（分） APACHEⅡ评分（分）
生存组              
0 h 15 549 ± 319 36 ± 24 749 ± 304 31 ± 8 12 ± 4 22 ± 7
2 h 15 432 ± 301 28 ± 23 594 ± 322 22 ± 14 - -
4 h 15 382 ± 309 26 ± 24 810 ± 509 20 ± 13 - -
6 h 15 417 ± 287 30 ± 22 950 ± 499 18 ± 10 - -
12 h 15 356 ± 225 31 ± 27 771 ± 411 13 ± 6 - -
24 h 15 319 ± 164 28 ± 17 801 ± 503 15 ± 4 11 ± 4 18 ± 6a
48 h 15 358 ± 260 21 ± 13 599 ± 187 16 ± 7 10 ± 4 16 ± 5a
死亡组              
0 h 13 492 ± 291 23 ± 19 957 ± 903 33 ± 20 14 ± 5 26 ± 6
2 h 13 465 ± 260 21 ± 18 591 ± 396 23 ± 13 - -
4 h 13 446 ± 304 21 ± 17 666 ± 394 21 ± 12 - -
6 h 13 424 ± 242 24 ± 22 731 ± 460 16 ± 5 - -
12 h 13 340 ± 168 24 ± 19 887 ± 787 16 ± 5 - -
24 h 13 396 ± 234 19 ± 14 944 ± 783 17 ± 8 14 ± 4 23 ± 6b
48 h 13 357 ± 216 14 ± 8 512 ± 260 14 ± 5 12 ± 3 20 ± 5ab
F值   0.045 1.805 0.002 0.012 2.165 5.371
P值   0.834 0.191 0.962 0.915 0.153 0.028
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