应用oXiris滤器CRRT治疗合并细胞因子风暴综合征的危重症COVID-19患者1例报告

doi:10.3877/cma.j.issn.2095-3216.2022.05.011

中华肾病研究电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 297 -299. doi: 10.3877/cma.j.issn.2095-3216.2022.05.011

病例报告

应用oXiris滤器CRRT治疗合并细胞因子风暴综合征的危重症COVID-19患者1例报告

曹文雅¹, 陈蕾¹, 薛瑾虹¹, 张冬菊¹, 蒋红利¹^,^†(

)

^1. 710061　西安，西安交通大学第一附属医院血液净化科

收稿日期:2022-01-21 出版日期:2022-10-28
通信作者: 蒋红利
基金资助:
陕西省重点研发计划(2020SF-181)

Application of oXiris filter-CRRT in the treatment of a critically ill COVID-19 patient with cytokine storm syndrome

Wenya Cao¹, Lei Chen¹, Jinhong Xue¹

Received:2022-01-21 Published:2022-10-28

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新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)中，病毒引起的细胞因子风暴综合征(cytokine storm syndrome, CSS)是自身免疫系统对新冠病毒(severe acute respiratory syndrome coronavirus 2, SARS-CoV-2)的过度反应，其特征是IL-6、IL-8、TNF-α、IL-1β、粒细胞巨噬细胞集落刺激因子(granulocyte-macrophage colony-stimulating factor，GM-CSF)等促炎性细胞因子不受控制地瀑布式激活以及释放，可导致严重的免疫病理损伤^[1]。由CSS引起的成人呼吸窘迫综合征已被证实是COVID-19患者的重要死亡原因^[2]。因此，控制过度的炎症被推测是治疗COVID-19的重要靶点。连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)尤其是应用oXiris滤器CRRT(oXiris-CRRT)在脓毒症等疾病当中，可以通过清除过度产生的细胞因子起到调节免疫紊乱的作用，其有效性得到了一定证实^[3]。然而oXiris-CRRT应用于COVID-19患者CSS治疗的临床实践，尚缺乏足够证据。我们应用oXiris-CRRT治疗一例重症COVID-19患者，CSS得到控制，病情明显好转。现报告如下，以便为临床实践提供参考。

图1 前3次oXiris滤器CRRT治疗及暂停后患者IL-6水平变化注：oXiris-CRRT：oXiris滤器CRRT；A：第一次oXiris-CRRT治疗患者血清及废液中IL-6水平的变化；B：第二次oXiris-CRRT治疗患者血清及废液中IL-6水平的变化；C：第三次oXiris-CRRT治疗患者血清及废液中IL-6水平的变化；D: oXiris-CRRT暂停后患者血清IL-6水平的变化；3次oXiris-CRRT治疗后，血清IL-6水平降至低于7 pg/ml，oXiris-CRRT暂停后患者IL-6水平再次升高

图2 oXiris滤器CRRT和血浆置换治疗期间患者IL-6水平变化注：CRRT：连续性肾脏替代治疗；oXiris-CRRT：oXiris滤器CRRT；TPE：血浆置换治疗；9次oXiris-CRRT和2次TPE后，IL-6水平逐渐下降至正常水平并趋于稳定

图3 患者治疗时间线注：Day：顺序日期；CRRT：连续性肾脏替代治疗；oXiris-CRRT：oXiris滤器CRRT；TPE：血浆置换治疗

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