连续性血液净化对重症急性胰腺炎免疫功能及内环境稳态的影响  

Effects of continuous blood purification(CBP) therapy on the immune function and stable state internal environment in severe acute pancreatitis

作　　者：陈剑[1] 陶晓根[1] 

机构地区：[1]安徽医科大学附属安徽省立医院重症医学科,合肥230001

出　　处：《肝胆外科杂志》2014年第6期427-430,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨连续性血液净化(CBP)治疗对于急性重症胰腺炎(SAP)患者维持内环境稳定及调节免疫功能的影响。方法选择安徽省立医院重症监护科(ICU)救治急性重症胰腺炎患者23例,入院12小时内即行CBP治疗,分别于治疗0、12、24、48h留血检测电解质、肌酐、尿素氮、血气分析;流氏细胞分析法测定T细胞亚群CD4+、CD8+、计算CD4+/CD8+的比值;酶联免疫吸附法(ELISA)法检测患者外周血IL-1、肿瘤坏死因子(TNF-α)的浓度,并观察在0、12、24、48 h时相的APACHEII评分。结果 1.SAP患者经CBP治疗后淋巴细胞CD4+、CD8+、CD4+/CD8+水平明显升高,且于24小时达高峰,炎症因子IL-1、TNF-α治疗后较治疗前水平下降(P<0.05);2.经CBP治疗后,血电解质紊乱迅速得到纠正,以血钙、钠等明显,肌酐和尿素氮都有不同程度下降,差异有统计学意义;3.CBP治疗后酸中毒纠正,血BE值及碳酸氢根恢复正常范围,血氧分压及氧饱和度较治疗前明显上升(P<0.05);4.APACHEII评分较治疗前下降明显(P<0.05)。结论急性重症胰腺炎患者体内不仅存在内环境紊乱,同时也存在免疫功能失调,连续性血液净化(CBP)治疗不仅可以维持内环境的稳定,同时可以清除升高的炎症因子,调节并改善患者的免疫功能,从而改善患者预后。Objective To investigate effects of continuous blood purification（CBP） therapy on the immune function and stable state internal environment. Methods 23 patients with severe acute pancreatitis were selected from the department of Critical Care Medicine,Anhui Provincial Hospital,all accepted CBP therapy within 12 hours,At the time points of 0,12,24,72 h during the treatment,electrolytes,urea nitrogen,creatinine,blood gas analysis were detected accordingly. Flow cytometry（FCM） was employed to detect CD4 ＋,CD8 ＋ and calculated the ratio of CD4 ＋ / CD8 ＋ T lymphocyte subsets in peripheral blood; Enzyme-linked immunosorbent（ELISA） method was detected IL-1,tumor necrosis factor（TNF-α） concentrations in peripheral blood of the patients,and observed in 0,12,24 and 48 h phase APACHEII scores. Results 1. SAP patients after treatment with CBP lymphocyte CD4 ＋,CD8＋,CD4 ＋ / CD8 ＋ levels increased significantly,and reached a peak at 24 h,Inflammatory cytokines IL-1,TNF-α l decreased after treatment than before（P〈0. 05）; 2. After CBP,blood electrolyte disorder was quickly corrected,Such as blood calcium,blood sodium,,creatinine and urea nitrogen have different degree of decline,the difference was statistically significant; 3. Acidosis was corrected after CBP,blood BE value and bicarbonate return to normal range,blood oxygen partial pressure and oxygen saturation were significantly increased after treatment（P〈0. 05）; 4. The APACHEII scores decreased significantly before the treatment（P〈0. 05）.Conclusion severe acute pancreatitis patients not only have internal environment disorder,but also have immune dysfunction. continuous blood purification（CBP） can maintain the stability of internal environment,at the same time,can remove elevated inflammatory factors,adjust and improve the patient＇s immune function,thus improving the prognosis of patients.

关 键 词：血液净化 重症胰腺炎 免疫 内环境 

分 类 号：R659[医药卫生—外科学]