配对血浆滤过吸附治疗多器官功能障碍综合征患者对单核细胞功能影响的研究  

Effects of Coupled Plasma Filtration Adsorption on the function of monocytes in MODS Patients

作　　者：毛慧娟[1] 余姝[1] 张波[1] 俞香宝[1] 张莉[1] 许贤荣[1] 沈霞[1] 王笑云[1] 邢昌赢[1] 

机构地区：[1]南京医科大学第一附属医院肾内科,210029

出　　处：《南京医科大学学报（自然科学版）》2008年第10期1279-1284,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京医科大学第一附属医院新技术引进项目基金资助

摘　　要：目的:研究新型血液净化方式——配对血浆滤过吸附(coupled plasma filtration adsorption,CPFA)治疗重症感染并多器官功能障碍综合征(MODS)患者对单核细胞功能的影响。方法:选择重症感染并MODS的患者7例,采用前瞻性,随机,自身交叉对照研究。每例患者均在常规药物治疗基础上加用配对血浆滤过吸附A(CPFA)(A)和高容量血滤(B)(high volume hemofiltration,HVHF)各治疗10h,A、B治疗顺序随机,间隔一夜洗脱期(12h),比较两种治疗方式对患者单核细胞表达HLA-DR的影响,同时检测两种治疗方式前、后患者全血自分泌或脂多糖(LPS)刺激分泌TNF-α的变化。另检测患者不同治疗时间点血清对THP-1细胞分泌功能的影响。结果:①CPFA治疗后,单核细胞HLA-DR的阳性率(%)变化(73.65±11.52vs.84.32±4.63)有显著性意义。(P=0.037)。HVHF治疗后,单核细胞HLA-DR阳性率未有明显改变(P>0.05)。②CPFA治疗后,患者全血在体外有或无脂多糖(LPS)刺激下,分泌TNF-α的量均明显高于治疗前(P<0.05);而HVHF治疗前、后,全血分泌TNF-α的量未有明显变化(P>0.05)。③随着CPFA的进行,患者血清抑制体外培养的THP-1细胞分泌TNF-α的功能逐渐减弱,至10h时分泌TNF-α的量较0h时有明显升高(P<0.05)。而随着HVHF的进行,患者血清抑制THP-1细胞分泌TNF-α的功能有减弱趋势,但未达到统计学意义。结论:与HVHF相比,CPFA治疗MODS在改善单核细胞抗原呈递功能和分泌功能方面,优于HVHF。CPFA具有重建机体免疫内稳态的作用。Objective：To investigate the effects of a novel extracorporeal blood purification therapy-coupled plasma filtration adsorption（CPFA） on the function of monocytes in the multiple organ dysfunction syndromes（MODS） patients with severe infection. Methods：This study was a pospective, pilot, crossover clinical trial. A total of seven patients diagnosed MODS with severe infection were selected in this study. Patients were randomly allocated to both 10 hrs of coupled plasma filtration adsorption plus bemodialysis （CPFA,treatment A） and 10 hrs of high volume hemo- filtration（HVHF,treatment B） with 12 h interval in random order,that was to say each patient receiving A＋B or B＋A randomly. Plasma monocyte HLA-DR expression and leukocyte TNF-α production（both spontaneous and lipopolysaccharide stimulating） were tested before and after the treatment. TNF-α production from normal human monocytes （THP-I cell） incubated with patients＇ plasma obtained at 0,5,10 h of the treatment was also measured. Results： ①The blood monoeyte HLA-DR expression（%） increased after CPFA（84.32 - 4.63 vs. 73.65 ± 11.52,P = 0.037） but no change after HVHV（P 〉 0.05）. ②Spontaneous and lipopolysaccharide inducing TNF-αproduction from patients＇ whole blood increased over time with CPFA （P 〈 0.05）. This increase was negative in HVHF group （P 〉 0.05）. （~Patients＇ serum suppressed production of TNF-α by cultured monocytes（THP-1 ）. This suppression effect decreased over time with CPFA（P 〈 0.05）. However,no significant difference was seen in HVHF group （P 〉 0.05）. Conelusion：CPFA was superior to HVHF in improving the antigen presentation ability of monocyte andrestoring lbukoeyte t＇esponsiveness to lipopolysaccharide, These findings suggest a potential role for CPFA in the treatment of MODS.

关 键 词：配对血浆滤过吸附 高容量血液滤过 多器官功能障碍综合征 吸附 HLA-DR 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]