连续性肾脏替代疗法对肺结核合并脓毒症患者的临床疗效：一项回顾性观察研究
Clinical Efficacy of Continuous Renal Replacement Therapy in Patients with Pulmonary Tuberculosis Complicated with Sepsis: A Retrospective Observational Study.
作者信息
Chen Xin, Lin Xiaoqing, Cheng Fang, Zheng Shilin, Zhang Qiang, Wu Te, Shi Jichan
机构信息
Department of Infectious Disease, Wenzhou Central Hospital, Dingli Clinical College of Wenzhou Medical University, Wenzhou City, Zhejiang Province, People's Republic of China.
出版信息
Infect Drug Resist. 2025 Apr 21;18:1975-1984. doi: 10.2147/IDR.S502113. eCollection 2025.
OBJECTIVE
To explore the clinical efficacy of continuous renal replacement therapy (CRRT) in patients with pulmonary tuberculosis (TB) complicated with sepsis, particularly focusing on 28-day mortality (primary objective), and to assess the impact of CRRT on inflammatory response, renal function, haemodynamics and overall prognosis (secondary objectives).
METHODS
A total of 98 patients with pulmonary TB complicated by sepsis were included: 49 patients were enrolled in the control group and received routine treatment, whereas 49 patients were enrolled in the CRRT group and received CRRT based on the control group. Renal function indicators, inflammatory indicators, haemodynamic indicators and recovery status were analysed and compared.
RESULTS
After 72 hours of treatment, C-reactive protein (CRP), serum creatinine (SCR), blood urea nitrogen (BUN) and plasma lactic in the CRRT group decreased ( < 0.001), procalcitonin (PCT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were reduced ( < 0.01) and urine volume and mean arterial pressure (MAP) increased ( < 0.001). After 72 hours of treatment, CRP and PCT in the control group increased ( < 0.05), SCR, BUN and NT-proBNP increased ( < 0.001), plasma lactic was not significantly changed and MAP decreased ( < 0.05). The 28-day mortality in the CRRT group was lower than in the control group (28.6% vs 49%, = 0.038), intensive care unit hospitalisation time was shorter than in the control group (11.27 ± 9.34 vs 15.43 ± 9.19 d, = 0.028) and Acute Physiological Function and Chronic Health Status Scoring System II and Sequential Organ Failure Score scores were lower after treatment ( < 0.001). The difference was statistically significant.
CONCLUSION
Continuous renal replacement therapy can significantly improve inflammatory response, enhance haemodynamics, promote renal function recovery and increase overall treatment efficacy in patients with pulmonary TB complicated with sepsis.
目的
探讨连续性肾脏替代疗法（CRRT）对肺结核（TB）合并脓毒症患者的临床疗效，尤其关注28天死亡率（主要目标），并评估CRRT对炎症反应、肾功能、血流动力学及总体预后的影响（次要目标）。
方法
共纳入98例肺结核合并脓毒症患者：49例患者纳入对照组并接受常规治疗，而49例患者纳入CRRT组并在对照组基础上接受CRRT治疗。分析并比较肾功能指标、炎症指标、血流动力学指标及恢复情况。
结果
治疗72小时后，CRRT组C反应蛋白（CRP）、血清肌酐（SCR）、血尿素氮（BUN）及血浆乳酸水平降低（<0.001），降钙素原（PCT）及N末端B型脑钠肽原（NT-proBNP）降低（<0.01），尿量及平均动脉压（MAP）升高（<0.001）。治疗72小时后，对照组CRP及PCT升高（<0.05），SCR、BUN及NT-proBNP升高（<0.001），血浆乳酸无明显变化，MAP降低（<0.05）。CRRT组28天死亡率低于对照组（28.6%对49%，P=0.038），重症监护病房住院时间短于对照组（11.27±9.34对15.43±9.19天，P=0.028），治疗后急性生理与慢性健康状况评分系统II及序贯器官衰竭评分降低（<0.001）。差异有统计学意义。
结论
连续性肾脏替代疗法可显著改善肺结核合并脓毒症患者的炎症反应，增强血流动力学，促进肾功能恢复并提高总体治疗效果。
Zotero 插件