连续性肾脏替代治疗对SIRS患者全身炎症反应的影响及机制研究  

The influence of continuous replacement therapy on systemic inflammatory response in patients with SIRS and the mechanism

作　　者：胡杰[1] 雷小敏[1] 陆元兰[1] 陈涛[1] 

机构地区：[1]遵义医学院附属医院重症医学科,563003

出　　处：《免疫学杂志》2015年第3期240-245,共6页Immunological Journal

基　　金：基金项目:黔科合J字[2009]2186 号

摘　　要：目的研究连续性肾脏替代治疗(CRRT)对全身炎症反应综合征(SIRS)患者炎症症状和炎性细胞因子水平影响及可能机制。方法 24例SIRS患者随机化分为一般治疗组和CRRT治疗组,每组12例。一般治疗组患者采用常规对症治疗、营养支持及敏感抗生素治疗;CRRT治疗组患者采用CRRT治疗,连续7 d;另设健康对照组12例。于入院当天及治疗后第1、3、5、7天分别记录患者治疗前后体温、呼吸、心率,计数外周白细胞数量,并检查外周血白细胞数量、血钾、血肌酐和HCO3-水平;分别抽取肝素抗凝静脉血,分离血浆和外周血单个核细胞(PBMC)。ELISA法检测血浆中TNF-α、IL-1β、IL-17水平和PBMC中NF-κB活性;免疫透射比浊法测定C反应蛋白(CRP)水平;采用real-time PCR检测PBMC中TLR2和TLR4 m RNA的表达。结果 CRRT治疗可明显减轻SIRS患者全身炎症反应症状,降低血浆TNF-α、IL-1β、IL-17和CRP水平,降低程度显著强于一般治疗组;CRRT治疗可时间依赖性地降低SIRS患者PBMC上TLR2、TLR4 m RNA表达和NF-κB活性,且治疗后各时间点的TLR2、TLR4 m RNA表达水平和NF-κB活性均显著低于一般治疗组。结论 CRRT可时间依赖性地缓解SIRS患者病情,减轻患者全身炎症反应,该作用可能是通过抑制Toll样受体表达和NF-κB活化而实现。This study aimed to investigate the effects of continuous renal replacement therapy（CRRT） on inflammatory response and pro-inflammatory cytokines levels of systemic inflammatory response syndrome（SIRS）patients and its possible mechanisms. Total of 24 cases of SIRS patients were randomized divided into conventional treatment group and CRRT treatment group. Patients were treated with conventional symptomatic treatment,nutritional support and antibiotics therapy in conventional treatment group, while patients in CRRT treatment group were treated with CRRT treatment for 7 days. Another 12 healthy people were observed as control. At days 0, 1, 3,5, 7 post-administration, body temperature, respiration, heart rate were recorded, and the number of peripheral white blood cells were counted. Furthermore, serum potassium, creatinine and HCO3-levels of SIRS patients were determined; plasma TNF-α, IL-1β, IL-17 levels and NF-κB activities in PBMC were detected by ELISA method.The levels of TLR2 and TLR4 m RNA in PBMC were detected by real time PCR assay. Data showed that CRRT treatment significantly alleviated inflammatory symptoms of SIRS patients, and reduced the levels of plasma TNF-α,IL-1β, IL-17 and CRP levels compared to conventional treatment group（P 0.05）. Meanwhile, CRRT treatment decreased the expression of TLR2, TLR4 m RNA and NF-κB activity in PBMC of SIRS patients in time-dependent manner, but those effects of CRRT treatment were significantly lower than that of conventional treatment at each time point（P 0.05）. In conclusion, CRRT can alleviate the symptoms of SIRS patients, and reduce the systemic inflammatory response in time-dependent manner. The effect of CRRT may closely relate to inhibition of TLR expression and NF-κB activation.

关 键 词：连续性肾脏替代治疗 全身炎症反应综合征 TOLL样受体 核转录因子ΚB 

分 类 号：R459.7[医药卫生—急诊医学]