脓毒症幼猪连续性静脉-静脉血液滤过中血清皮质醇及炎性介质水平的变化  

Changes of Serum Cortisol,Inflammatory Mediator Levels in Continuous Veno-Venous Hemofiltration in Sepsis Pigs

作　　者：李艳红[1] 宋国维[2] 张琪[2] 甘小庄[2] 崔小岱[3] 岳梅[3] 孙春荣[3] 

机构地区：[1]北京协和医学院研究生院,北京100730 [2]首都儿科研究所附属儿童医院急诊科,北京100020 [3]首都儿科研究所中心实验室,北京100020

出　　处：《实用儿科临床杂志》2010年第12期930-932,952,共4页Journal of Applied Clinical Pediatrics

基　　金：国家科技攻关计划课题(2003BA712A11-10)

摘　　要：目的观察脓毒症幼猪连续静脉-静脉血液滤过(CVVH)中血清皮质醇、巨噬细胞移动抑制因子(MIF)、IL-6、IL-10水平的动态变化。方法 12头健康雄性幼猪静脉内注入0.3 mL.kg-1(5×1012CFU.L-1)大肠杆菌,注菌后0.5 h随机分为滤过组和对照组,每组各6头。采用ELISA法检测2组注菌前、治疗后2 h、4 h、6 h、8 h血清皮质醇和MIF、IL-6、IL-10水平。结果对照组注射后血清皮质醇水平升高,4 h达到峰值,后逐渐下降,8 h低于滤过组及注菌前基础值(Pa<0.05)。滤过组血清皮质醇水平各时间点无明显变化,2 h、4 h、6 h明显低于对照组。对照组注菌后血清MIF水平升高,2 h达峰值。滤过组MIF水平注菌前较基础值升高,2 h达峰值,但低于对照组峰值,滤过组、对照组注菌后各时间点MIF水平均高于基础值,且滤过组低于对照组(Pa<0.01,0.05)。滤过组MIF/皮质醇比值治疗后4 h、6 h、8 h均低于对照组(Pa<0.01,0.05)。对照组注菌后IL-6水平升高,4 h达到峰值,后仍保持较高水平。滤过组IL-6水平4 h达峰值,之后IL-6水平降低较明显。滤过组、对照组注菌后各时间点IL-6水平均高于基础值,且滤过组低于对照组(Pa<0.01,0.05)。对照组注菌后血清IL-10水平持续升高。滤过组IL-10水平增高,2 h达峰值,之后逐渐下降。对照组注菌后各时间点IL-10水平均高于注菌前基础值,滤过组注菌后2 h、4 h、6 h IL-10水平高于基础值,且滤过组低于对照组(Pa<0.05)。结论 CVVH可明显降低脓毒症幼猪血清皮质醇、MIF、IL-6、IL-10水平,下调MIF/皮质醇比值,CVVH可能是临床治疗脓毒症的一种有效手段。Objective To explore the dynamic changes of serum levels of cortisol,migration inhibitory factor（MIF）,IL-6 and IL-10 in sepsis immature pigs received continuous veno-venous hemofiltration（CVVH）.Methods Sepsis pig was induced by E.coli femoral vein injection[3 mL·kg-1（5×1012 CFU·L-1）] into 12 healthy male immature pigs.The pigs were randomly divided into control group（n=6） and treatment group（n=6）.The latter underwent CVVH,which started 0.5 h later after E.coli femoral vein injection.The post-CVVH time course of the plasma cortisol,MIF,IL-6 and IL-10 levels were studied at before treatment and 2 h,4 h,6 h and 8 h after treatment.Results In the control group,levels of cortisol increased after E.coli injection and reached the highest at 4 h,and then gradually dropped,at 8 h the level was lower than that in the treatment group and at 0 h（Pa0.05）.In the treatment group,levels of cortisol were lower than those in the control group at 2 h,4 h,and 6 h after the beginning of CVVH.The cortisol level of treatment group changed slightly.Levels of MIF in the control group after E.coli injection increased,and reached the highest at 2 h.In the treatment group,levels of MIF increased and reached the highest at 2 h.But the highest was lower than that in control group.In the treatment group and control group,levels of MIF at 2 h,4 h,and 6 h were higher than that at 0 h.At 2 h,4 h,6 h and 8 h,MIF in the treatment group were lower than those in control group（Pa0.01,0.05）.The ratio of MIF/cortisol dropped obviously after CVVH.The ratios of MIF/cortisol of the treatment group at 4 h,6 h,and 8 h were lower than those in control group（Pa0.01,0.05）.In the control group,levels of IL-6 increased after E.coli injection and reached the highest at 4 h,and then remained high levels.In the treatment group,levels of IL-6 reached the highest at 4 h and then dropped evidently.Levels of IL-6 in the control group and the treatment group after E.coli injection were significantly higher than that at 0 h.And the level

关 键 词：脓毒症 连续性静脉-静脉血液滤过 皮质醇 巨噬细胞移动抑制因子 白细胞介素-6 白细胞介素-10 

分 类 号：R720.597[医药卫生—急诊医学]