连续性血液净化对SAP患者RAAS及炎症因子的影响

Effects of continuous blood purification on RAAS and inflammatory factors in patients with SAP

摘要:

目的  探讨连续性血液净化对重症急性胰腺炎（SAP）患者肾素-血管紧张素-醛固酮系统（RAAS）及炎症因子的影响。方法  选取在该院住院治疗的重症急性胰腺炎患者64例，随机分为治疗组和对照组。治疗组在接受基础治疗的同时接受连续性血液净化治疗，对照组接受基础治疗，比较两组患者主要症状、指标恢复正常时间及治疗有效率的差异。比较两组患者治疗前和治疗后1、3和7 d时各RAAS指标和各炎症因子的差异。结果  治疗组患者治疗后腹痛、恶心、C反应蛋白（CRP）、血清淀粉酶（AMS）恢复正常时间均低于对照组，且差异有统计学意义（P <0.05）；治疗组总的有效率（31例，91.18%）高于对照组（21例，70.0%），差异有统计学意义（P <0.05）。两组在治疗后各RAAS指标与治疗前比较均降低，治疗组在治疗后1和3 d时的血管紧张素Ⅰ、血管紧张素Ⅱ、肾素、醛固酮均低于对照组，差异有统计学意义（P <0.05）；两组在治疗后各炎症因子与治疗前比较均降低，治疗组在治疗后1、3和7 d时的白细胞介素6（IL-6）、白细胞介素8（IL-8）、CRP均低于对照组，差异有统计学意义（P <0.05）；治疗组在治疗后1和3 d时的肿瘤坏死因子α（TNF-α）低于对照组，且差异有统计学意义（P <0.05）。结论  连续性血液净化治疗重症急性胰腺炎患者，在改善RAAS和炎症因子激活以及疗效方面均优于基础治疗。

Abstract:

Objective To investigate the effects of continuous blood purification on RAAS and inflammatory factors in patients with severe acute pancreatitis (SAP). Methods Sixty-four cases of SAP treated in our hospital were selected and randomly divided into treatment group and control group. The treatment group received basic treatment and continuous blood purification therapy, at the same time, the control group received basic treatment. The main symptoms, index recovery time and treatment efficiency were compared between the two groups. The differences in RAAS indexes and the inflammatory factors before and 1, 3 and 7 days after treatment were compared between the two groups. Results The recovery time of abdominal pain, nausea, CRP and AMS in the treatment group was significant shorter than that in the control group (P < 0.05). The total effective rate of the treatment group (31 cases, 91.18%) was higher than that of the control group (21 cases, 70%), and the difference was statistically significant (P < 0.05). In the two groups the RAAS index decreased after treatment; angiotensin I, angiotensin Ⅱ, renin and aldosterone levels in the treatment group were significantly lower than those in the control group 1 and 3 days after treatment (P < 0.05). In the two groups, various inflammatory factors after treatment were decreased compared with those before treatment; IL-6, IL-8 and CRP in the treatment group 1, 3 and 7 days after treatment were significantly lower than those in the control group (P < 0.05); TNF-α of the treatment group 1 and 3 days after treatment was significantly lower than that of the control group (P < 0.05). Conclusions Continuous blood purification is better in the improvement of RAAS, activation of inflammatory factors and curative effect than the foundation treatment in treatment of patients with severe acute pancreatitis.