连续性肾脏替代治疗过程中外周血细胞因子浓度的变化  

Serum cytokine concentrations in acute renal failure patients during continuous renal replacement therapy

作　　者：谢红浪[1,2,3] 季大玺[1,2,3] 龚德华[1,2,3] 汪义军 黎磊石[1,2,3] 

机构地区：[1]南京军区南京总医院 [2]解放军肾脏病研究所 [3]解放军普通外科研究所

出　　处：《中国危重病急救医学》1999年第4期226-228,共3页Chinese Critical Care Medicine

摘　　要：目的：研究连续性肾脏替代治疗（ＣＲＲＴ）过程中外周血中肿瘤坏死因子（ＴＮＦ）、白细胞介素８（ＩＬ８）和内皮衍生血管舒张因子一氧化氮（ＮＯ）浓度的变化。方法：５例重症急性肾功能衰竭（肾衰）患者在明确诊断之后即开始行ＣＲＲＴ，每天持续１０～１２小时。血管通路采用动静脉内瘘或颈内静脉留置导管，ＡＫ１０血泵建立体外循环，血滤器采用ＦＨ６６Ｄ型（聚酰胺膜，０．６ｍ２）。治疗前和治疗１、２、３、６、９和１２小时（或结束时）取血和超滤液检测ＴＮＦ、ＩＬ８和ＮＯ的浓度。结果：５例患者均存活且肾功能恢复正常。ＣＲＲＴ开始１小时后外周血中ＴＮＦ浓度轻度升高，但在治疗过程中缓慢降低，６小时达到最低水平，与治疗前相比差异十分显著〔（１０８０±５３５）ｎｇ／Ｌ比（１６８０±７８３）ｎｇ／Ｌ，Ｐ＜０．０１〕，随后直到１２小时，其浓度基本稳定无显著变化；ＩＬ８浓度也在６小时降至最低值，但与治疗前比较无统计学差异〔（３９４±１２１）ｎｇ／Ｌ比（４６８±１４８）ｎｇ／Ｌ，Ｐ＞０．０５〕。ＮＯ水平在ＣＲＲＴ开始后亦缓慢降低，９小时达到最低值，但与治疗前相比差异不显著〔（９６±４８）μｍｏｌ／Ｌ比（１０６±４３）μｍｏｌ／Ｌ，Ｐ＞０．０５〕；超?Objective:To observe changes in serum concentrations of tumor necrosis factor (TNF),interleukin8(IL8) and nitric oxide (NO) during continuous renal replacement therapy (CRRT).Methods: 5 acute renal failure (ARF) patients with an average blood urea nitrogen(BUN) of (24 2±6 8) mmol/L and creatinine of (655 7±189 9)μmol/L were treated with CRRT after diagnosis.CRRT was begun at 8:00 AM,lasted for 10 to 12 hours and ceased at night.FH66D hemofilter (Gambro,Polyamide,0 6 m 2) was used,and blood sample were collected before and 1,2,3,6,9 and 12 hours after CRRT.Results:All the patients survived and their renal function recovered.TNF levels slightly elevated at 1 hour after CRRT and decreased progressively,reaching trough level at 6 hours (1 080±535)ng/L vs.(1 680±783)ng/L, P <0 01 .NO concentrations significantly decreased at 9 hours ( P <0 05) compared with that at 2 hours,while IL8 concentrations were not marked changed during treatment (96±48)μmol/L vs.(106±43)μmol/L, P >0 05 .In addition,these cytokines could not be detected in the ultrafiltration fluid.Conclusions:Serum TNF,IL8 and NO levels could reduce to low values at 6 to 9 hours during CRRT with FH66D hemofilter.The results suggest that the clearance of these mediators may mainly be due to absorption but not filtration,and early renewal of hemofilter may increase the clearance.

关 键 词：肾功能衰竭 CRRT 肿瘤坏死因子 IL-8 一氧化氮 

分 类 号：R692.5[医药卫生—泌尿科学]