连续性血液净化治疗对热射病多器官功能不全患者内皮功能障碍的影响  

Influence of continuous blood purification therapy on endothelial cell function of the patients with multiple organ dysfunction syndrome induced by heat stroke

作　　者：杨剑虹[1] 唐忠志[1] 刘非凡[1] 刘洁[1] 邵素花[1] 程青[1] 赵智刚[1] 邬明[1] 陈晓娟[1] 程军[1] 叶明[1] 彭岚[1] 

机构地区：[1]广州军区武汉总医院急诊科,湖北武汉430070

出　　处：《中国急救医学》2012年第5期437-440,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 连续性血液净化（continuous blood purification,CBP）治疗对热射病（heat stroke,HS）患者内皮功能障碍的影响.方法 以27例HS导致的多器官功能不全综合征（multiple organ dysfunction syndrome,MODS）患者作为研究对象,所有患者行持续静静脉血液滤过（CVVH）48 h;以健康成人为对照.测定患者治疗前后血清可溶性血栓调节蛋白（sTM）、血管生成素-2（Ang-2）的水平.以患者CBP治疗各时间点的血清作用于人脐静脉内皮细胞,检测细胞凋亡、细胞对荧光素标记的葡聚糖4000（FD4）的通透性.结果 与正常对照组比较,HS患者血清sTM、Ang-2水平明显增高（P〈0.05）,患者血清导致内皮细胞凋亡、FD4的通透性增高（P〈0.05）.CBP治疗后HS患者血清sTM、Ang-2水平明显下降（P〈0.05）,患者血清导致内皮细胞凋亡、FD4的通透性明显下降（P〈0.05）.结论 CBP治疗通过清除血液中致内皮损伤的物质,改善HS所致MODS患者的内皮功能障碍.Objective To investigate the influence of continuous blood purification （CBP） therapy on endothelial cell function in the patients with multiple organ dysfunction syndrome （MODS） induced by heat stroke （HS）. Methods Twenty - seven patients with MODS induced by HS were observed. All the patients underwent continuous veno- venous hemofihration （CVVH） for 48 h. Before and during CVVH, serum concentrations of soluble thrombomodulin （ sTM）, angiopoietin - 2 （ Ang - 2） were measured. Monolayer HUVEC cells were incubated with patient ~s serum, then the rates of apoptosis cells and the change of epithelial permeability to FIM were detected. Results Compared with the normal controls, HS patients showed the increase of serum sTM, Ang - 2 （ P 〈 0.05 ）. After CBP treatment, serum concentrations of sTM, Ang - 2 were decreased （ P 〈 0.05 ）. Serum of HS patients induced the increase cell apoptosis, the permeability to FIM of monolayer HUVEC cells （ P 〈 O. 05 ）. After CBP treatment, serum - induced increase of cell apoptosis and permeability to FIM were attenuated （P 〈 0.05）. Conclusion CBP improves patients＇ endothelial cell function.

关 键 词：热射病 连续性血液净化 可溶性血栓调节蛋白 血管生成素-2 细胞凋亡 FD4通透性 

分 类 号：R59[医药卫生—内科学]