HVHF及CVVHDF治疗MODS犬的疗效比较  

The Curative Effect of HVHF and CVVHDF for Multiple Organ Dysfunction Syndrome in Dogs

作　　者：胡磊[1] 王梅红[1] 隋晓露 努尔孜叶 杨文君[1] 麻冰 陈继红[1] 

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054

出　　处：《中国中西医结合肾病杂志》2016年第5期395-399,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：教育部新世纪优秀人才基金资助项目(No.NCET-12-1077)

摘　　要：目的:探讨高容量血液滤过(HVHF)和连续性静-静脉血液透析滤过(CVVHDF)对多脏器功能障碍综合征(MODS)犬治疗中的疗效。方法:采用二次打击建立犬MODS模型,18只犬随机分MODS组(n=6)、CVVHDF组(n=6)和HVHF组(n=6),CVVHDF组及HVHF组分别给予CVVHDF及HVHF治疗24 h;MODS组不给予治疗。于术前(T1),内毒素注射前(T2),内毒素注射完毕后0 h(T3)、3 h(T4)、6 h(T5)、9 h(T6)、12 h(T7)、18 h(T8),24 h(T9)留取血标本,ELISE法测定血浆中CD14、LPS、IL-1β、IL-4、HMGB-1、TGF-β浓度。MODS组、CVVHDF组及HVHF组建模后24 h处死前取肺、心、肝、肾、脑组织器官,Western Blot法检测各脏器组织CD14、HMGB-1蛋白表达。结果:CVVHDF及HVHF治疗后LPS、CD14、IL-1β、IL-4、HMGB-1浓度水平均进行性下降,在T6~T9显著低于MODS组(P<0.01),而TGF-β浓度水平则进行性升高,在T5~T9显著高于MODS组(P<0.01),治疗过程中CVVHDF及HVHF组间差异无统计学意义(P>0.05)。CVVHDF及HVHF治疗后,各组织中CD14、HMGB-1蛋白表达均有所降低,其中CVVHDF组肝脏及脑组织CD14蛋白表达显著低于MODS组(P<0.01),CVVHDF组肺脏、肾脏及脑组织HMGB-1蛋白表达显著低于MODS组(P<0.01),HVHF组肺脏、心脏、肝脏及脑组织CD14蛋白表达显著低于MODS组(P<0.01),HVHF组各脏器HMGB-1蛋白表达均显著低于MODS组(P<0.01),CVVHDF组及HVHF组在各脏器CD14、HMGB-1蛋白表达差异未见统计学意义(P>0.05)。结论:CVVHDF及HVHF均可削弱血循环中LPS、CD14、HMGB-1、IL-1β和IL-4等炎症介质的峰值浓度,重建免疫平衡,重建免疫系统内稳状态;均可下调肺脏、心脏、肝脏、肾脏及脑组织中CD14、HMGB-1蛋白表达,有效遏制过度的炎症反应,从而防治MODS。Objective ：To investigate the efficacy of high volume hemofihration （HVHF） and continuous veno -venous he- modiafihration （CVVHDF） in the treatment of multiple organ dysfunction syndrome （MODS） in dogs. Methods：Two- hit method was used to establish the dog MODS model. Eighteen dogs were randomly divided into MODS group （n = 6） , CVVHDF group （n = 6） and HVHF group （ n = 6）. CVVHDF group and HVHF group were given CVVHDF and HVHF treatment 24 h while MODS group was not treated. Blood samples were taken before operation （ T1 ）, before LPS injection （ T~ ） and 0 h （ T3 ）, 3 h （ T4 ）, 6 h （ Ts ）, 9 h （ T6 ）, 12 b （ T7 ）, 18 h （ Ts ） and 24 h （ T9 ） after LPS inj ected. The concentration of C D^4, LPS, [L - 113, IL - 4, HMGB - 1, TGF - 13 in plasma were detected by ELISE method. Lung, heart, liver, kidney, brain tissue and organ of dogs in MODS group, CVVHDF group and HVHF group were taken after the construction of the model and before 24 hours killed. Protein express levels of CD14 and HMGB 1 in main organ tissues were detected by fluorescent detection of Western blot. Results：After CVVHDF and HVHF treatment, the concentration of CD14 ,LPS ,IL- 113 ,IL-4 ,HMGB -1 ,TGF- 13 in plasma decreased significantly at T6 ~ T9 compared with those in MODS group （P 〈 O. 01 ） and TGF - 13 increased at T5 ~ T9 compared with that in MODS group （ P 〈 0.01 ）. No significant differ- ence between the two treatment groups in CVVHDF and HVHF （P 〉 O. 05）. After CVVHDF and HVHF treatment, CD14, and HMGB - 1 protein expression were decreased in mian organs. CD^4 protein expression in liver and brain tissue of CVVHDF group were signif- icantly lower than MODS group （P 〈 0.01 ） and HMGB - 1 protein expression in the lungs, kidney and brain tissue were significantly lower than MODS group （P 〈 0. 01 ）. While CDI4 protein expression in lungs, heart, liver and brain tissue of HVHF group were significantly lower than MODS group （P 〈 0.01） and HMGB -

关 键 词：高容量血液滤过 连续性静-静脉血液透析滤过 多脏器功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]