早期高容量短时血液滤过对重症急性胰腺炎犬血浆细胞因子的影响  

Effect of Early Short-term High-volume Hemofiltration on Serum Cytokines of the Dogs with Severe Acute Pancreatitis

作　　者：曾皓[1] 夏亮[1] 吕农华[1] 舒宏春[1] 

机构地区：[1]南昌大学第一附属医院消化科,南昌330006

出　　处：《江西医学院学报》2007年第6期40-44,共5页Acta Academiae Medicinae Jiangxi

摘　　要：目的观察早期高容量短时血液滤过(EHSVVH)对重症急性胰腺炎(SAP)犬血浆中TNF-α、IL-6和IL-10的影响。方法采用逆行胰胆管内注射5%牛磺胆酸钠法建立SAP模型。随机分为对照组(A组)和治疗组(B组),A组用单纯呼吸机治疗+假治疗(血液在滤器内循环,不接置换液,不超滤);B组用机械通气+高容量血液滤过治疗,以前稀释方式输入超滤液。监测造模前、造模后及治疗2、4、6h血浆TNF-α、IL-6、IL-10水平,观察胰腺组织学变化。结果与A组相比,B组4、6h血浆TNF-α、IL-6较低(P<0.01),而IL-10水平于B组4h出现一波峰(P<0.05);两组胰腺病理学评分无显著差别(P>0.05)。结论ESHVVH可有效降低SAP犬血浆中的促炎因子TNF-α、IL-6的水平;升高抗炎因子IL-10,从而纠正促炎因子和抗炎因子失衡。有望成为临床早期治疗及预防SAP合并多脏器功能障碍综合征的有效方法。Objective To investigate the effect of early short time high volume venovenous hemofihration（ESHVVH） on plasma level of TNF-α. IL-6. IL-10, pancreas injury. Methods SAP models were established by retrograde injection of 5 % sodium taurocholate into the main pancreatic duct under the surgery. Sixteen healthy hybrid dogs were randomly allocated into groups A and B. The animals in group A received the treatment of ESHVVH,while Group B was just a control group. Blood samples were collected at the same points（before and 0 hour,2 hour,4hour, 6hour after the induction of severe acute pancreatitis）,plasma concentrations of TNF-α,IL-6,IL- 10 were measured. The specimens of pancreas were collected for histopathologic analysis. Results Histopathological score of pancreas,the difference between two groups was not significant（P〉 0.05）. The level of TNF-α and IL-6 in plasm increased significantly（P〈0.01）in group A than that in group B at 4hour and 6 hour. In group B, plasma level of IL-10 was not significantly changed compared with group A except for at the point of 4 hour,when plasma level of IL-10 sig- nificantly higher than that in group B（P〈0.05）. Conclusion ESHVVH could reduce the plasma concentrations of pro-inflammatory cytokines TNF-α and IL-6 of SAP dogs. So through ESHVVH,the imbalance of pro-inflammatory and anti-inflammatory cytokines has been corrected at early stage. ESHVVH can remove inflammatory mediators in the plasm effectly,so that it can be an important method for treating SAP and MODS.

关 键 词：重症急性胰腺炎 多脏器功能障碍综合征 血液滤过 肿瘤坏死因子-α 白介素-6 白介素-10 

分 类 号：R-332[医药卫生]