连续性血液净化对心脏术后多脏器功能障碍综合征患者炎性介质和氧化应激的影响  

Effect of continuous blood purification on inflammatory mediators and oxidative stress in patients with MODS after cardiac surgery

作　　者：王汉民[1] 连耀国[1] 刘宏宝[1] 孙世仁[1] 陈威[1] 

机构地区：[1]第四军医大学西京医院肾脏内科,西安710032

出　　处：《中国血液净化》2006年第11期769-772,共4页Chinese Journal of Blood Purification

基　　金：西京医院临床高新技术资助项目(No.XJGX02004Z04)

摘　　要：目的前瞻性观察连续性血液净化(CBP)对心脏术后多脏器功能障碍综合征(MODS)存活者与死亡者炎性介质和氧化应激指标的影响。方法16例心脏术后MODS伴ARF的患者使用HF700型聚砜膜血液滤过器行CBP治疗,8例存活(A组),8例死亡(B组);分别在治疗前(0h)和治疗后2、6、12、24和48h取血检测两组患者血清TNF-α、IL-6、IL-8、IL-4、丙二醛(MDA)、超氧化物歧化酶(SOD)和总抗氧化能力(TAC)等指标的变化。结果CBP治疗2h后A组促炎因子TNF-α、IL-6迅速下降,24h后IL-8明显下降,而死亡组治疗过程中上述炎性介质水平较治疗前无明显变化;两组抗炎因子IL-4在CBP治疗过程中较治疗前有所下降,但无明显统计意义。A组TAC在CBP治疗6h后明显下降,MDA在12h后明显下降,SOD在24h后明显下降;B组SOD、TAC在治疗2h后即开始明显下降,MDA在48h的治疗过程中持续保持高水平,较治疗前无明显下降。结论CBP有助于改善MODS患者促炎因子与抗炎因子的平衡,减轻炎性损伤。CBP能改善MODS患者的氧化应激,减轻氧化损伤。在CBP治疗过程中,TNF-α、IL-6、IL-8、MDA浓度持续高水平及SOD早期下降者预后差;动态监测上述指标可能有助于判断心脏术后MODS患者的预后。Objective To evaluate prospectively the effect of continuous blood purification （CBP） on inflammatory mediators and oxidative stress in survivors and non survivors with multiple organ dysfunction syndrome（MODS） and acute renal failure（ARF） after cardiac surgery. Methods Sixteen patients with MODS and ARF after cardiac surgery were treated with CBP（used HF700 hemofilter）, and were divided into two groups： Eight survivors（group A） and eight non survivors （group B）.The serum levels of TNF-α, IL-6, IL-8, IL-4, malondialdehyde（MDA）, superoxide dismutase（SOD） and total anti oxidant capacity（TAC） before the start of CBP and after CBP for 2, 6, 12, 24 and 48 hours were examined and registered. Results After a 2 hours＇ treatment of CBP, there was a significant reduction of the serum levels of TNF- α and IL-6, and after 24 hours＇ IL-8 was significantly decreased in the group A; but there were no significant decrease in the group B. During a 48 hours treatment of CBP, there was no significant reduction of the serum levels of IL-4 in the both groups. In group A, after a 6 hours treatment of CBP, TAC was significantly reduced, after 12 hours, MDA was significantly decreased, and after 24 hours SOD was significantly decreased. In group B, after a 2 hours＇ treatment of CBP, SOD and TAC was significantly the whole process of CBP. Conclusion CBP can reduced, MDA was remain in higher levels during improve the imbalance of oxidative and antioxidative systems and reduce damage caused by inflammatory mediators. CBP can improve the imbalance of proinflammatory cytokine and anti-inflammatory cytokine and reduce damage caused by inflammatory mediators. During the process of CBP, the prognosis is poor when the serum levels of TNF- α, IL-6, IL-8 and MDA are sustained high while SOD is significantly decreased early. The ambulatory examination of serum levels of those markers may be valuable for evaluating prognosis of patients with MODS and ARF after cardiac surgery.

关 键 词：连续性血液净化 多脏器功能障碍综合征 氧化应激 炎症介质 心脏术后 

分 类 号：R459.5[医药卫生—治疗学] R654.2[医药卫生—临床医学]