刘德海

【摘要】 目的：探討不同剂量甲泼尼龙联合连续性肾脏替代疗法（CRRT）对脓毒血症患者炎症因子及免疫功能的影响。方法：选取2017年12月-2019年12月期间于本院治疗的98例脓毒血症患者，按照年龄、性别组间具有可比性原则，将其分为对照组与观察组，每组49例。两组患者均采用CRRT治疗，在此基础上对照组加用常规剂量甲泼尼龙治疗，观察组加用小剂量甲泼尼龙治疗。比较两组患者治疗后炎症因子及免疫功能指标，统计两组患者1周内、1个月内存活率，记录两组患者治疗期间不良反应。结果：治疗后，两组免疫细胞CD8+均上升，CD4+、CD4+/CD8+均下降，但观察组改善情况优于对照组（P<0.05）;两组治疗后肿瘤坏死因子（TNF-α）、白细胞介素-6（IL-6）、降钙素原（PCT）均下降，但观察组改善情况优于对照组（P<0.05）;观察组1周内、1个月内存活率高于对照组（P>0.05）;观察组治疗期间不良反应发生率低于对照组（P<0.05）。结论：低剂量甲泼尼龙联合CRRT治疗脓毒血症疗效确切，更利于控制炎症因子活性，改善免疫功能，提高生存率，利于预后。

【关键词】 脓毒血症 炎症反应 免疫功能 连续性肾脏替代疗法 甲泼尼龙

The Effect of Methylprednisolone Combined with CRRT on Inflammatory Factors and Immune Function in Patients with Sepsis/LIU Dehai. //Medical Innovation of China， 2021， 18（01）： 0-061

[Abstract] Objective： To investigate the effect of different doses of methylprednisolone combined with continuous renal replacement therapy （CRRT） on inflammatory factors and immune function in patients with sepsis. Method： A total of 98 patients with sepsis who were treated in our hospital from December 2017 to December 2019 were divided into control group and observation group according to the principle of comparability between age and gender groups， 49 cases in each group. Both groups were treated with CRRT. On this basis， the control group was treated with conventional dose Methylprednisolone， and the observation group was treated with low dose Methylprednisolone. After treatment， the inflammatory factors and immune function indexes of the two groups were compared， the memory activity rate of the two groups within one week and one month was counted， and the adverse reactions of the two groups during the treatment were recorded. Result： After treatment， CD8+ immune cells in both groups increased， CD4+ and CD4+/CD8+ decreased， but the improvement of the observation group was better than that of the control group （P<0.05）; after treatment， TNF-α， IL-6 and PCT decreased in both groups， but the improvement of the observation group was better than that of the control group （P<0.05）; the memory activity of the observation group in one week and one month was higher than that of the control group （P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group （P<0.05）. Conclusion： Low dose methylprednisolone combined with CRRT is effective in the treatment of sepsis. It is more conducive to control the activity of inflammatory factors， improve the immune function， improve the survival rate and prognosis.

[Key words] Sepsis Inflammatory response Immune function Continuous renal replacement therapy Methylprednisolone

First-authors address： Jiamusi Central Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.01.015

脓毒血症是一种因感染所致的全身器官功能障碍的全身炎症反应综合征，病情危重、病死率极高[1]。即使医疗技术在不断提高，抗感染或器官支持等治疗技术有重大突破性进展，但脓毒血症的病死率仍高达30%～70%[2]。据流行病学调查发现，脓毒血症病死率远远高于心肌梗死，是ICU中非心脏疾病死亡的主要原因[3]。目前，对于脓毒血症的治疗多采用连续性肾脏替代疗法（CRRT）配合药物治疗，CRRT是一种通过体外循环血液净化方式来连续、缓慢净化血液，清除水及溶质的治疗技术，属于近年来较为常用的治疗脓毒血症方法[4]。甲泼尼龙是一种肾上腺糖皮质激素，具有较强的消炎作用，多用于治疗自身免疫性炎症性疾病。……