乌司他丁辅助高容量血液滤过对脓毒症患者血清TLR4、NT-proBNP水平的影响

摘要

Objective:To explore the effect of Ulinastatin adjuvant to high-volume hemofiltration on serum levels of TLR4 and NT-proBNP in patients with sepsis.Methods:130 patients with sepsis were divided into observation group and control group randomly.The observation group was treated with Ulinastatin adjuvant to high-volume hemofiltration,and the control group was given high-volume hemofiltration only.The curative effectiveness and changes of serum TLR4 and NT-proBNP were compared between two groups.Results:APACHE Ⅱ score,Marshal score and SOFA score were significantly lower in two groups after treatment than those before treatment (P ＜ 0.05),but the decreased degree in observation group was significantly higher than in control group (P ＜ 0.05).There was no significant difference in PT,APTT,FIB and PLT before treatment between the two groups (P ＞ 0.05),and after treatment,the PT and APTT decreased (P ＜ 0.05),and FIB and PLT increased (P ＜ 0.05),but the changes in observation group were more obvious (P ＜ 0.05).The levels of serum TLR4 and NT-proBNP showed no significant difference between the two groups before treatment (P ＞ 0.05),and those in observation group were significantly lower than those in control group after treatment (P ＜ 0.05).The incidence of MODS and DIC,and mortality rate in the observation group were significantly lower than in the control group (P ＜ 0.05).Conclusion:Ulinastatin adjuvant to high-volume hemofiltration can improve the therapeutic effectiveness by improving the coagulation function,and reducing the levels of serum TLR4 and NT-proBNP in sepsis patients.%目的:探讨乌司他丁辅助高容量血液滤过(HVHF)对脓毒症患者血清Toll样受体家族(TLRs)、氨基末端脑钠肽前体(NT-proBNP)水平的影响.方法:130例脓毒症患者依据随机数字表法分为观察组和对照组,每组65例,观察组采用乌司他丁辅助HVHF治疗,对照组采用HVHF治疗,比较2组疗效及血清TLR4、NT-proBNP水平变化.结果:治疗后2组患者APACHEⅡ、Marshal和SOFA评分均显著降低(均P＜0.05),且观察组降低幅度更大(P＜0.05);治疗前,2组PT、APTT、FIB、PLT值差异无统计学意义(均P＞0.05),治疗后PT、APTT明显降低,FIB、PLT明显升高(均P＜0.05),但观察组变化更为明显(P＜0.05).治疗前2组患者血清TLR4、NT-proBNP水平比较,差异无统计学意义(均P＞0.05),治疗后2组均有不同程度的下降(均P＜0.05),观察组治疗后血清TLR4、NT-proBNP水平显著低于对照组(P＜0.05);观察组多器官功能障碍综合征(MODS)、弥漫性血管内凝血(DIC)发生率和病死率均显著低于对照组(均P ＜0.05).结论:乌司他丁辅助HVHF能够改善脓毒症患者凝血功能,降低患者血清TLR4、NT-proBNP水平,提高脓毒症治疗效果.