血液灌流联合血液滤过对脓毒症患者内毒素清除及免疫功能重建的临床研究  

Clinical Study of Hemoperfusion Combined with Hemofiltration on Endotoxin Removal and Immune Function Reconstruction in Septic Patients

作　　者：杨剑明 徐鹏[2] 周立冬 徐为公[4] Yang Jianmin;Xu peng;Zhou Lidong;Xu Weigong(Department of Nephrology,Tianjin Quanjian Cancer hospital,Tianjin 301707,China;Tianjin Centers for Disease Control and Prevention;Tianjin Yang Quan medical device Co.,Ltd.,Tianjin 300050,China;medical college of Chinese people＇s armed police forces,Tianjin 300162,China)

机构地区：[1]天津权健肿瘤医院肾内科,301707 [2]天津市疾病预防控制中心,300011 [3]天津市阳权医疗器械有限公司,300050 [4]中国人民武装警察部队医学院,300162

出　　处：《辽宁医学杂志》2018年第4期14-17,共4页Medical Journal of Liaoning

基　　金：科技部国家高技术研究发展计划(863计划)重大项目资助(2015AA033904);天津市中高端重大专项课题(15ZXQXSY00070)

摘　　要：目的研究血液灌流(HP)联合连续性高容量血液滤过(CHVHF)对脓毒症(spesis)患者体内内毒素清除及免疫功能重建的作用。方法采用急性生理与慢性健康评分(APACHEⅡ)筛选,脓毒症或脓毒症休克患者随机分为两组,对照组用CHVHF治疗,试验组用CHVHF联合HP治疗。检测两组治疗前(0h)及治疗后不同时间点血浆中内毒素、肿瘤坏死因子(TNF-α)、白介素6(IL-6)、10(IL-10)水平、T细胞亚群CD4+与CD8+比值及单核细胞分子标志HLA-DR(人类白细胞抗原DR型)的变化;监测血流动力学、乳酸及氧合指数(PO2/Fi O2)的变化,观察28天病死率。结果两组患者年龄、性别比、APACHEⅡ评分比较,差异均无统计学意义(P> 0. 05)。治疗后两组内毒素都下降,只试验组降至正常水平且与对照组比较差别有统计学意义(P <0. 05);试验组治疗2 h、24h、72 h后IL-6、IL-10、TNF-a三种炎症因子与治疗前比较均有下降(P <0. 01),而对照组只在治疗后72 h,各炎症因子水平与治疗前比较有下降(P <0. 01);治疗后36h、72h的CD4+百分比、CD4+/CD8+比值及单核细胞HLA-DR的表达水平,试验组高于同时段对照组(P <0. 05)。治疗后72h后两组患者血流动力学均正常,与各组治疗前比较差异均有统计学意义(P <0. 01),其中N E、PO2/Fi O2试验组恢复优于对照组(P <0. 05);治疗后28天,试验组无死亡,对照组病死率50%。结论双亲型吸附材料填充的血液灌流器联合CHVHF治疗在清除内毒素及炎症细胞因子,重建机体免疫平衡,降低死亡率方面优于单用CHVHF方法,在脓毒症抢救治疗中具有广阔的临床应用前景。Objective To study the effect of hemoperfusion device filled with amphipathic adsorbent resin combined with continuous high-volume hemofiltration（ CHVHF） on endotoxin elimination and immune function reconstruction in septic patients. Methods Patients with sepsis or septic shock were randomized into two groups according to the Acute Physiology and Chronic Health Evaluation（ APACHEII）,the control group were treated with CHVHF,the experimental group were treated with CHVHF combined with hemoperfusion（ HP）. The changes of endotoxin,Tumor necrosis factor alpha（ TNF-α）,Interleukin 6（ IL-6） and10（ IL-10）,analysis of T cell-subsets,ratio of CD4＋/CD8＋,rate of monocyte with HLA-DR in both groups were detected before and after treatment; the changes of hemodynamics,lactic acid and oxygenation index（ PO2/Fi O2） were monitored,the 28-day mortality was observed. Results There were no significant differences in the age,sex and APACHE II score between the two groups. Endotoxin in both groups decreased after treatment,the experimental group dropped to the normal reference level and had significant difference compared with control group（ P〈 0. 05）; levels of TNF-α,IL-6 and IL-10 in experimental group at 2 h,24 h and72 h after treatment were obviously droped than those at before treatment（ P〈 0. 01） respectively,levels of three inflammatory factors were decreased after treated 72 h in control group compared with before treatment respectively（ P〈 0. 01）; the percentage of CD4＋,CD4＋/CD8＋ratio and rate of monocyte with HLADR in experimental group were significantly higher than those in control group respectively at 36 h and 72 h（ P〈 0. 05）. Hemodynamics,Lactic acid and Oxygenation index were up to normal levels 72 h after treatment,there were significant differences between before and after treatment in each group respectively（ P〈 0. 01）,NE and PO2/Fi O2 in experimental group recovered better than those in control group（ P〈 0. 05）. There was no one dead in exp

关 键 词：血液灌流 连续性高容量血液滤过 脓毒症 内毒素 细胞因子 

分 类 号：R459.7[医药卫生—急诊医学]