血液滤过联合血液灌流对脓毒症免疫抑制患者免疫功能的影响  

Effect of hemofiltration combined with hemoperfusion on improvement of immune function in septic patients with immunosuppression

作　　者：赵丹[1] 惠姣洁[1] 梁锋鸣[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023

出　　处：《生物医学工程与临床》2017年第6期596-599,共4页Biomedical Engineering and Clinical Medicine

基　　金：国家自然科学基金资助项目(81401619)

摘　　要：目的研究血液滤过联合血液灌流对脓毒症免疫抑制患者免疫功能的影响。方法选择70例脓毒症免疫抑制患者,其中男性42例,女性28例;年龄39~78岁,平均年龄56.32岁。随机分为对照组(34例)和试验组(36例)。两组患者均按《2012国际严重脓毒症及脓毒症休克诊疗指南》治疗,试验组在此基础上,于第1~3天行血液滤过(模式为连续性静脉-静脉血液滤过,前稀释量4 L/h)联合血液灌流治疗。分别观察两组患者治疗前及治疗后第3天、第7天外周血单核细胞人类白细胞抗原(HLA)-DR、CD3^+百分比(%)、CD4^+百分比(%)、CD4^+/CD8^+比值的变化。并比较两组患者机械通气时间、重症监护病房(ICU)住院时间、28 d病死率。结果与对照组相比,试验组治疗第3、7天HLA-DR表达逐渐升高,且显著高于对照组。与对照组相比,试验组治疗3、7 d CD3^+百分比、CD4^+百分比、CD4^+/CD8^+比值显著升高,试验组机械通气时间、ICU住院时间均明显缩短,28 d病死率明显下降。结论血液滤过联合血液灌流能有效改善脓毒症免疫抑制患者的HLA-DR表达水平及T细胞亚群稳态,一定程度上改善患者免疫功能,并可改善其预后。Objective To investigate the effect on improving immune function by hemofiltration combined with hemoperfusion in septic patients with immunosuppression. Methods A total of 70 septic patients with immunosuppression were enrolled,which included 42 males and 28 females, aged 39-78 years old with mean age of 56.32 years old. All of them were randomly divided into experimental group（n = 34） and control group（n = 36）. The patients were treated with standardization treatment（Surviving Sepsis Campaign： International Guidelines for Management of Severe Sepsis and Septic Shock： 2012）. The hemofil-tration combined with hemoperfusion were added performed in experimental group within 1-3 days（mode was continuous static-venous hemofiltration, pre-dilution 4 L/h）. The expression of human leukocyte antigen DR（HLA-DR） in peripheral blood mononuclear cells, the changes of CD3~＋percentage（%）, CD4~＋percentage（%） and CD4~＋/CD8~＋ratio before the treatment and 3,7 days after treatment were monitored. The duration of mechanical ventilation, hospitalization time of intensive care unit（ICU）,and 28-day survival rate were evaluated in both groups. Results Compared with control group, the HLA-DR expression at 3,7 days after treatment in experimental group gradually increased, which was significantly higher than that in control group. The CD3~＋percentage, CD4~＋percentage, CD4~＋/CD8~＋ratio at 3, 7 days after treatment in experimental group gradually increased and the duration of mechanical ventilation and hospitalization time of ICU in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated. Conclusion It is demonstrated that hemofiltration combined with hemoperfusion could improve the expression of HLA-DR and the level of T lymphadenitis in septic patients with immunosuppression,which could improve immune function and prognosis of sepsis patients in certain degree.

关 键 词：血液滤过 血液灌流 脓毒症 人白细胞DR抗原 T细胞亚群 

分 类 号：R459.7[医药卫生—急诊医学]