中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (05): 326-330.doi: 10.3969/j.issn.1671-4091.2022.05.006

• 临床研究 • 上一篇    下一篇

CVVH联合HA330血液灌流对创伤脓毒症急性肾损伤患者血清HMGB1、hs-CRP、PCT水平及28天死亡的影响

梁文生1吴伟1王敏2   

  1. 暨南大学附属广州红十字会医院
  • 收稿日期:2021-10-19 修回日期:2022-03-01 出版日期:2022-05-12 发布日期:2022-05-12
  • 通讯作者: 梁文生 E-mail:liuLimingI@163.com

Effects of CVVH combined with HA330 hemoperfusion on serum HMGB1, hs-CRP and procalcitonin levels and 28-day mortality in post-traumatic sepsis patients with acute kidney injury 

LIANG Wen-sheng1, WU Wei1, WANG Min2   

  1. Department of Emergency and 2Department of Orthopedics, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou 510220, China
  • Received:2021-10-19 Revised:2022-03-01 Online:2022-05-12 Published:2022-05-12

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摘要： 目的探讨连续性静脉-静脉血液滤过(continuousveno-venoushemofiltration，CVVH)联合HA330血液灌流(hemoperfusion，HP)对创伤后脓毒症急性肾损伤患者血清高迁移率族蛋白1(highmobilitygroupprotein1，HMGB1)、高敏C反应蛋白(high-sensitiveC-reactiveprotein，hs-CRP)、降钙素原(procalcitonin，PCT)水平及28天死亡的影响。方法采用回顾性分析法，选取2020年2月～2021年3月暨南大学附属广州红十字会医院收治的86例创伤后脓毒症合并急性肾损伤(acutekidneyinjury，AKI)患者的临床资料，根据是否同意接受HA330血液灌流治疗分为HP组43例和CVVH组43例，CVVH组接受CVVH治疗，HP组在CVVH基础上联合HA330血液灌流器治疗，观察2组患者治疗前和治疗后3d、5d血清肌酐(Scr)、尿素氮(BUN)、HMGB1、hs-CRP、PCT水平及急性生理学及慢性健康状况评分系统(acutephysiologyandchronichealthevaluationscoringsystem，APACHEⅡ)评分及序贯器官衰竭评分(sequentialorganfailureassessment，SOFA)变化，并记录24h尿量及28天死亡情况。结果治疗后3d、5d，HP组患者尿量较CVVH组多(3d:t=-8.158,P=＜0.001；5d:t=-12.954,P=＜0.001)，血清Scr、BUN、PCT、hs-CRP、HMGB1水平及APACHEⅡ评分、SOFA评分均低于CVVH组[3d:t=9.698、P＜0.001,t=3.313、P=0.001,t=7.739、P＜0.001,t=7.266、P＜0.001,t=2.549、P=0.006,t=7.340、P＜0.001,t=3.556、P＜0.001；5d:t=7.189、P＜0.001,t=2.385、P=0.010,t=14.583、P＜0.001,t=5.676、P＜0.001,t=2.797、P=0.003,t=11.238、P＜0.001,t=6.964、P＜0.001]。与CVVH组相比，HP组住院时间[(12.37±5.11)d比(20.69±5.04)d，t=9.324，P＜0.001]、机械通气时间更短[(9.36±2.47)d比(14.09±2.85)d，t=8.224，P＜0.001]，SOFA＜8分患者28d病亡率更低[5.00%比23.26%，χ2=8.444，P=0.004]。结论CVVH联合HA330血液灌流治疗创伤后脓毒症急性肾损伤能提高治疗效果，减轻炎症反应，促进肾功能恢复，降低28天死亡率。

关键词: 血液滤过, 血液灌流, 脓毒症, 急性肾损伤, 病亡率

Abstract: Objective  To investigate the effects of continuous veno-venous hemofiltration (CVVH) combined with HA330 hemoperfusion (HP) on serum high mobility group protein 1 (HMGB1), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and 28-day mortality in post-traumatic sepsis patients with acute kidney injury (AKI).   Methods  A total of 86 patients with post-traumatic sepsis and AKI treated during February 2020 to March 2021 in Guangzhou Red Cross Hospital Affiliated to Jinan University were retrospectively analyzed. They were divided into CVVH group (43 cases) and HP group (43 cases) according to whether the patient agreed to receive HA330 hemoperfusion treatment. CVVH group received CVVH treatment, and HP group was treated with the HA330 hemoperfusion device on the basis of CVVH. Blood creatinine (Scr), blood urea nitrogen (BUN), serum levels of HMGB1, hs-CRP and PCT, and scores of APACHE Ⅱ and sequential organ failure assessment (SOFA) were recruited from both groups before treatment and after the treatment for 3 and 5 days. 24-hour urine volume and 28-day mortality were recorded.  Results  After treatment for 3 days and 5 days, the urine volume increased more in HP group than in CVVH group (for 3 days:  t=-8.158, P＜0.001; for 5 days: t=-12.954, P＜0.001). Serum levels of Scr, BUN, PCT, hs-CRP and HMGB1, and scores of APACHE Ⅱ and SOFA were significantly lower in HP group than in CVVH group (for 3 days:  t=9.698, 3.313, 7.739, 7.266, 2.549, 7.340 and 3.556 respectively, P<0.001, =0.001, <0.001, <0.001, =0.006,  <0.001 and <0.001 respectively; for 5 days: t=7.189, 2.385, 14.583, 5.676, 2.797, 11.238 and 6.964 respectively, P<0.001, =0.010, <0.001, <0.001, =0.003, <0.001 and <0.001 respectively). The hospitalization days and mechanical ventilation days were lower in HP group than in CVVH group (for hospitalization days: 12.37±5.11 vs. 20.69±5.04 days, t=9.324, P＜0.001; for mechanical ventilation days: 9.36±2.47 vs. 14.09±2.85 days, t=8.224, P＜0.001). Patients with SOFA score <8 had a lower 28-day mortality rate (5.00% vs. 23.26%, χ2=8.444, P=0.004).  Conclusion  CVVH combined with HA for the treatment of post-traumatic sepsis patients with AKI can significantly reduce the inflammation responses, promote the recovery of renal function, and reduce the 28-day mortality with better therapeutic effects.

Key words: Hemofiltration, Hemoperfusion, Sepsis, Acute renal injury, Mortality

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