连续性血液透析滤过对多器官功能障碍犬器官功能和细胞因子的影响  

Effects of continuous venovenous hemodiafiltration on organ function and cytokines in dogs with multiple organ dysfunction syndrome

作　　者：陈继红[1] 刘健[1] 张建龙[2] 李玉芳[1] 

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054 [2]新疆医科大学基础医学院病理生理教研室

出　　处：《中华肾脏病杂志》2008年第4期253-258,共6页Chinese Journal of Nephrology

基　　金：新疆维吾尔自治区自然科学基金（200821114）

摘　　要：目的观察连续性血液透析滤过（CVVHDF）对多器官功能障碍综合征（MODS）犬器官功能和细胞因子的影响，并探讨CVVHDF治疗MODS的机制。方法15只Beagle犬采用失血性休克＋复苏灌注＋内毒素血症复制MODS模型，随机分为CVVHDF组（n=8）和MODS组（n=7）。内毒素注射完毕后CVVHDF组接受CVVHDF治疗12h；MODS组未接受CVVHDF治疗。检测各时间点动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、Scr、BUN的水平。ELISA检测血浆TNF-α、IL-6、IL-10浓度。结果CVVHDF治疗后血浆IL-6、IL-10显著下降，在3、6、9及12h时间点显著低于MODS组，差异均有统计学意义（P〈0．01）；血浆TNF-α浓度无明显变化，两组间各时间点差异无统计学意义。超滤液中检出IL-6、TNF-α，筛选系数分别为0．27±0．13、0．1±0．1，但未能检出IL-10。CVVHDF组各主要器官功能均明显改善，平均动脉压基本保持在正常水平，尤其在6、9及12h时间点显著高于MODS组，差异均有统计学意义（P〈0．01）。PaO2逐渐升高，与MODS组在3、6、9及12h时间点比较，差异均有统计学意义（P〈0．01）。结论连续性血液透析滤过能有效降低血浆IL-6、IL-10水平，使抗炎反应和促炎反应两方面趋于动态平衡；能明显改善内毒素诱导的低血压，提高动脉血氧分压。Objective To investigate the effects of continuous venovenous haemodiafiltration （CVVHDF） on major organ function and plasma cytokine levels in MODS dogs. Methods Fifteen Beagle dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to establish MODS model, then dogs were randomly divided into 2 groups： CVVHDF group （n=8） and MODS group without CVVHDF （n=7）. CVVHDF was performed for 12 hours after endotoxin injection in CVVHDF group dogs. Serum ALT, AST, Scr, BUN and blood gas were routinely measured, and plasma TNF-α, IL-6 and IL-10 concentrations were measured by ELISA at different time points. Results Plasma levels of IL-6 and IL-10 were significantly decreased in the CVVHDF group at 3 h, 6 h, 9 h and 12 h after endotoxin injection as compared with MODS group （P〈0.01）. TNF-α levels were similar in both groups （P〉0.05）. IL-6 and TNF-α were detected in the ultrafiltrate. The sieving coefficients （SC） for IL-6 and TNF-α were 0.27±0.13 and 0.1±0.1 respectively. IL-10 could not be detected in the ultrafiltrate. In CVVHDF group, function of major organs was improved. The beneficial effect of CVVHDF on the hypotension of MODS dogs was particularly striking at 6 h, 9 h, and 12 h after endotoxin injection （P〈0.01）. Mean PaO2 in CVVHDF groups at 3 h, 6 h, 9 h, and 12 h after endotoxin injection was significantly higher than that in MODS group （P〈0.01）. Conclusion CVVHDF effectively removes IL-6 and IL-10 from the circulation, attenuates endotoxin-induced hypotension and improves arterial oxygenation in MODS dogs.

关 键 词：多器官功能衰竭 血液透析滤过 细胞因子 

分 类 号：R459.7[医药卫生—急诊医学]