CVVH疗法对全身炎症反应综合征及脓毒血症患者内皮功能损伤标志物的影响  

Continuous venous-venous hemofiltration therapy on the markers for endothelial injury in systemic inflammatory response syndrome and sepsis patients

作　　者：薛骏[1] 刘骏峰[1] 李铭新[1] 施雪枫[1] 丁峰[1] 陆福明[1] 顾勇[1] 林善锬[1] 

机构地区：[1]复旦大学附属华山医院肾内科,上海200040

出　　处：《中国血液净化》2007年第10期545-547,共3页Chinese Journal of Blood Purification

基　　金：国家"211"工程2期

摘　　要：目的初步探讨连续血液净化疗法CBP(continuous blood purification)对全身炎症反应综合症(SIRS)及脓毒血症(Sepsis)患者内皮功能损伤标志物的影响。方法选择复旦大学附属华山医院肾内科15例SIRS或伴Sepsis患者,分别留取CVVH(continuous venous-venous homofiltrtion,连续静脉静脉血液滤过)治疗前后的血浆,直接检测血栓调节蛋白(sTM,soluble thrombomodulin)、E-选择素、细胞间黏附分子-1(sICAM-1,soluble intercellular adhesion molecule-1)浓度。APACHⅡ评分评价临床疗效。结果临床转归:8名SIRS组患者,CVVH治疗后第4天APACHⅡ评分较治疗前显著改善(P<0.01),而7名Sepsis组患者的APACHⅡ评分更加恶化。SIRS组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照组(P<0.01);Sepsis组患者血浆sTM、sICAM-1、sE-选择素浓度显著高于正常对照和SIRS组(P<0.01);CVVH治疗后1周,SIRS组患者sTM、sE-选择素较治疗前明显降低(P<0.05),而Sepsis组患者无明显降低(P>0.05)。结论SIRS/Sepsis患者内皮细胞存在明显的激活和损伤,CVVH治疗能部分改善SIRS患者内皮细胞功能,而对Sepsis患者效果不佳。Objective Efforts were made to investigate the effects of continuous venous-venous hemofiltration （CVVH） on the markers for endothelial injury in systemic inflammatory response syndrome and sepsis （SIRS/sepsis） patients. Methods Soluble thrombomodulin （sTM）, soluble intercellular adhesion molecule-1 （sICAM-1）, soluble E-selectin in plasma were measured by ELISA before and after CVVH treatment in 15 SIRS/sepsis patients. APACH Ⅱ scores were used to evaluate the CVVH effects. Results APACH Ⅱ scores improved on the 4th day after the treatment in 8 SIRS patients, but worsened in 7 sepsis patients. Plasma sTM, sICAM-1 and E-selectin were significantly higher in SIRS/sepsis patients than in normal controls, and were higher in sepsis patients than in SIRS patients. On the 7th after the treatment, plasma sTM and sE-selectin de- creased remarkably in SIRS patients but not in sepsis patients. Conclusion Endothelial activation and injury occur in SIRS/sepsis patients. CVVH can partially improve the endothelial function in SIRS patients but not in sepsis patients.

关 键 词：内皮细胞 连续静脉静脉血液滤过 血栓调节蛋白 细胞黏附分子 E-选择素 

分 类 号：R459.5[医药卫生—治疗学]