摘要
目的探讨连续性肾脏替代治疗(CRRT)联合血液灌流治疗对急性百草枯(PQ)中毒患者预后的影响及机制。方法60例急性PQ中毒患者随机均分为对照组(HA330灌流器血液灌流治疗)和观察组(CRRT+HA330灌流器治疗),连续处理5 d,收集2组患者的一般资料;分别于治疗前和治疗后第3天,采集2组急性PQ中毒者外周静脉血5 mL,离心取上清,采用酶联免疫吸附法检测血清PQ、丙二醛(MDA)及髓过氧化物酶(MPO),采用全自动生化分析仪和酶联免疫吸附法检测血清谷丙转氨酸(ALT)、总胆红素(TBIL)、肌酸激酶同功酶(CK-MB)、血肌酐(Scr)水平,采用双抗体夹心酶联免疫吸附法和散射比浊法检测血清白细胞介素-6(IL-6)、IL-1及C-反应蛋白(CRP),采用流式细胞仪检测免疫功能指标(CD3+、CD4+及CD8+);随访并记录2组急性PQ中毒患者出院后1个月内的生存情况,采用Kaplan-Meier法绘制生存曲线。结果2组急性PQ中毒患者治疗后第3天PQ、MDA、MPO水平均低于治疗前(P<0.05),观察组治疗后第3天PQ、MDA及MPO水平均低于对照组(P<0.05);治疗后第3天观察组急性PQ中毒患者血清TBIL、ALT、Scr及CK-MB均低于对照组(P<0.05),对照组急性PQ中毒者治疗后第3天TBIL、ALT、Scr及CK-MB水平均高于治疗前(P<0.05);治疗后第3天观察组急性PQ中毒者IL-6、IL-1及CRP均低于对照组(P<0.05),2组治疗后第3天血清IL-6、IL-1及CRP水平均分别低于治疗前(P<0.05);治疗后第3天观察组急性PQ中毒者CD3+、CD4+及CD4+/CD8+均高于对照组(P<0.05),2组急性PQ中毒者治疗后第3天CD3+、CD4+及CD4+/CD8+水平均分别高于治疗前(P<0.05)。结论与单独血液灌流治疗比较,CRRT联合血液灌流治疗可有效清除PQ中毒患者血液中的有毒物质,其机制可能与降低炎症因子水平及改善肝肾功能有关。
Objective To investigate the effects of continuous renal replacement therapy(CRRT)combined with hemoperfusion on the prognosis and cytokine level of patients with acute paraquat(PQ)poisoning.Methods Sixty patients with acute PQ poisoning were randomly divided into the control group(HA330 hemoperfusion treatment)and the observation group(CRRT+HA330 hemoperfusion treatment)and the treatment lasted for 5 days.The general data of the two groups were collected,Before treatment and on the third day after treatment,5 mL of peripheral venous blood from the patients of the two groups was collected,and the supernatant was centrifuged.The serum PQ,malondialdehyde(MDA),and myeloperoxidase(MPO)were detected by enzyme-linked immunosorbent assay(ELISA).Serum ALT,TBIL,CK-MB,and Scr levels were examined by automatic biochemical analyzer and ELISA.Interleukin-6(IL-6),IL-1,and C-reactive protein(CRP)were detected by double-antibody sandwich ELISA and scattering turbidimetry.The immune function indexes(CD3+,CD4+,CD8+)were detected by flow cytometry.The two groups were followed up and recorded within 1 month after discharge.Kaplan-Meier method was used to plot the survival curve.Results On the 3day after treatment,the levels of PQ,MDA,and MPO of both groups were significantly lower than those before treatment(P<0.05),and the levels of PQ,MDA,and MPO in the observation group were significantly lower than those in the control group(P<0.05).TBIL,ALT,Scr,and CK-MB in the observation group were lower than those in the control group(P<0.05),while the levels of TBIL,ALT,Scr,and CK-MB in the control group were higher than those before treatment(P<0.05).IL-6,IL-1,and CRP in the observation group were lower than those in the control group(P<0.05),and the levels of serum IL-6,IL-1,and CRP in 2 groups were lower than those before treatment(P<0.05).CD3+,CD4+,and CD4+/CD8+in the observation group were higher than those in the control group(P<0.05).And the levels of CD3+,CD4+,and CD4+/CD8+in the 2 groups were higher than those before treatment(P<0.05).Conclusion Compared with hemoperfusion alone,CRRT combined with hemoperfusion can effectively remove blood toxins and improve the levels of inflammatory factors and liver and kidney functions in patients with PQ poisoning.
作者
刘晓曼
余厚友
龚晓亮
戴晓刚
王建龙
范乔
郭风
高烨
LIU Xiaoman;YU Houyou;GONG Xiaoliang;DAI Xiaogang;WANG Jianlong;FAN Qiao;GUO Feng;GAO Ye(Department of Emergency,Xi'an International Medical Center Hospital,Xi'an 710100,Shanxi,China;Department of Emergency,the First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 710061,Shanxi,China)
出处
《贵州医科大学学报》
CAS
2022年第12期1416-1421,1428,共7页
Journal of Guizhou Medical University
基金
国家自然科学基金(81601674)。
关键词
百草枯
中毒
细胞因子类
预后
连续性肾脏替代治疗
血液灌流
paraquat(PQ)
poisoning
cytokines
prognosis
continuous renal replacement therapy(CRRT)
blood perfusion
