比较羟乙基淀粉和乳酸林格液对脓毒症患者血中促炎／抗炎因子浓度的影响  

Effects of hydroxyethyl starch and lactate Ringer＇s solution on plasma inflammatory factors in patients with sepsis

作　　者：胡志霞[1] 李吉[1] 张远炎[1] 

机构地区：[1]浙江大学医学院第一附属医院北仑分院宁波市北仑区人民医院普外科,浙江宁波315800

出　　处：《中国急救医学》2013年第7期627-629,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 观察乳酸林格液（LRS）和6%羟乙基淀粉（HES）130/0.4对脓毒症患者血浆中促炎/抗炎细胞因子浓度的影响.方法 60例脓毒症患者随机分为两组：Ⅰ组为LRS组,1 h内输注20 mL/kg LRS;Ⅱ组为HES组,1 h内输注等量HES.于输注前（T0）、输注完毕时（T1）、输注后24 h（T2）和输注后48 h（T3）时,采用酶联免疫吸附法（ELISA）检测血浆白细胞介素-1β（IL-1β）、TNF-α、IL-4、IL-10、IL-17和TGF-β1浓度.结果 与T0比较,LRS组T1、T2和T3时间点TNF-α和IL-1β浓度明显升高（P〈0.05）,IL-4、IL-10、IL-17和TGF-β1浓度明显下降.与T0比较,HES组T1、T2和T3时间点IL-1β、和TNF-α浓度变化不明显,IL-4、IL-10、IL-17和TGF-β1浓度明显升高（P〈0.05）.HES组T1、T2和T3时间点IL-1β和TNF-α浓度明显低于LRS组（P〈0.05）,IL-4、IL-10和IL-17、TGF-β1浓度明显高于LRS组（P〈0.05）.结论 6%HES130/0.4能有效抑制脓毒症患者血浆促炎细胞因子反应,促进抗炎细胞因子生成,有效恢复促炎/抗炎细胞因子平衡.Objective To observe effects of lactate Ringer＇s solution （LRS） and 6% hydroxyethyl starch β0/0.4 on inflammatory/anti - inflammatory cytokines in plasma of sepsis patients. Methods Sixty cases of sepsis patients were randomly divided into two groups： group I for sodium lactate Ringer＇s solution （LRS） group, 20 mL/kg LRS was inputted in 1 h; group II, hydroxyethyl starch （HES） group, equivalent HES was inputted in 1 h; before infusion （TO）, at the end of infusion （ T1 ）, 24 h after infusion （T2） and 48 h after infusion （ 33 ）, interteukin - 1β （ IL - 1β ）, TNF - α, IL -4, IL - 10, IL - 17 and TGF - β1 were detected by enzyme linked immunosorbent assay （ELISA）. Results Compared with TO, TNF - α and IL - 1β in LRS group were increased significantly at T1, T2 and 33 time points （P 〈0.05） ; IL -4, IL - 10, IL - 17 and TGF - β1 were decreased significantly （ P 〈 0. 05 ）. Compared with TO, TNF - α and IL - 1 β in HES group did not change significantly at T1, T2 and T3 time points; IL -g, IL - 10, IL - 17 and TGF - β1 increased significantly （P 〈0.05）. IL - 1 β and TNF - α protein content in HES group at T1, T2 and 33 time points was significantly lower than that in LRS group （P 〈0.05） ; the level of IL-4, IL- 10 and IL- 17, TGF- β1 in HES group at T1, T2 and 33 time points was higher than that of LRS group （P 〈 0.05）. Conclusion 6% HES β0/0.4 can inhibit proinflammatory cytokine response of the patients with sepsis, and promote anti- inflammatory cytokines （ IL -4, IL - 10, IL - 17 and TGF - β1 ） generation, and recover inflammatory cytokine balance.

关 键 词：乳酸林格液(LRS) 6%羟乙基淀粉(HES) 脓毒症 细胞因子 

分 类 号：R541.4[医药卫生—心血管疾病]