双亲型吸附树脂血液灌流器联合血液滤过对脓毒症患者免疫功能重建的临床研究  

Immunological reconstruction for patients with sepsis by amphiphilic adsorbent resin hemoperfusion combined with hemofiltration

作　　者：于杰 杨剑明[2] 崔辉[3,4] 向勇平 刘爱兵[3,4] YU Jie;YANG Jianming;CUI Hui;XIANG Yongping;LIU Aibing(Tianjin Yangquan Medical Instrument Limited Company,Tianjin 300350,China;Department of Kidney Medicine,Tianjin Port Hospital,Tianjin 300350,China;Medical Experiment Center,General Hospital of Chinese People's Armed Police Force,Beijing 100039,China;Beijing Key Laboratory of Disater Rescue Medicine,Beijing 100039,China)

机构地区：[1]天津阳权医疗器械有限公司,300350 [2]天津港口医院肾病内科,300350 [3]武警总医院医学实验中心,北京100039 [4]灾害救援医学北京市重点实验室,北京100039

出　　处：《中华灾害救援医学》2018年第9期498-501,共4页Chinese Journal of Disaster Medicine

基　　金：国家高技术研究发展计划(2015AA033904)

摘　　要：目的探究双亲型吸附树脂血液灌流器联合血液滤过在脓毒症患者免疫功能重建中的作用。方法选取2015-02至2017-10天津港口医院收治的37例脓毒症或脓毒症休克患者为研究对象,运用简单随机法将其分为对照组(n=18)和试验组(n=19)。对照组采取连续性高容量血液滤过(continuous high-volume hemofiltration,CHVHF)治疗,试验组采取CHVHF联合血液灌流(hemoperfusion,HP)治疗。分别检测两组患者血液中白细胞分化抗原4+(cluster of differentiation 4+,CD4+)、白细胞分化抗原8+(cluster of differentiation 8+,CD8+)、人白细胞DR抗原(human leukocyte antigen-DR,HLA-DR)水平及血浆中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)水平。结果 (1)免疫细胞及HLA-DR表达水平:组间比较显示,试验组患者治疗后3 d、6 d的HLA-DR表达水平高于对照组,差异有统计学意义(P<0.05);组内比较显示,试验组治疗后3 d、6 d的HLA-DR表达水平,治疗后6 d的CD4+、CD4+/CD8+表达水平均较治疗前升高,差异有统计学意义(P<0.05);对照组治疗后3 d、6 d的CD4+、CD4+/CD8+表达水平较治疗前升高,差异有统计学意义(P<0.05)。(2)炎性因子变化:组间比较显示,试验组患者治疗后72 h的IL-6、TNF-α较对照组低,差异有统计学意义(P<0.05);组内比较显示,试验组与对照组治疗后72 h的IL-6、TNF-α均较0 h降低,差异有统计学意义(P<0.05)。结论双亲型吸附树脂血液灌流器联合血液滤过治疗脓毒症能快速清除机体免疫应答产生的细胞因子,利于机体的免疫功能重建。Objective The objective of this study was to explore the effect of amphiphilic adsorbent resin hemofiltration combined with hemoperfusion on immunological reconstruction in patients with sepsis.Methods A total of 37 cases of sepsis or septic shock who were treated in Tianjin Port Hospital from February 2015 to October 2017 were selected and were randomly divided into control group(n=18)and experimental group(n=19)by simple randomization.The control group was given continuous high-volume hemofiltration(CHVHF),while the experimental group was treated by CHVHF combined with hemoperfusion(HP).The levels of CD4+(cluster of differentiation 4+),CD8+(cluster of differentiation 8+),human leukocyte antigen-DR(HLA-DR)in blood and tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in plasma were measured and compared between the two groups.Results(1)Immune cells and HLA-DR:inter-group comparison showed that HLA-DR at 3 d and 6 d following the treatment in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05);inner-group comparison showed that HLA-DR at 3 d and 6 d following the treatment in the experimental group were higher than those at the time point of 0 d,CD4+and CD4+/CD8+in the experimental group at 6 d following the treatment were higher than those at the time point of 0 d,and the differences were statistically significant(P<0.05);CD4+and CD4+/CD8+at 3 d and 6 d following the treatment in the control group were higher than those at the time point of 0 d,and the differences were statistically significant(P<0.05);(2)Inflammatory factor comparison:inter-group comparison showed that the IL-6 and TNF-αat 72 h following the treatment in the experimental group were lower than those in the control group,and the differences were statistically significant(P<0.05);innergroup comparison showed that these two index in the experimental group and control group at the time point of 72 h following the treatment were higher than those at the time point of 0 h,and

关 键 词：免疫功能重建 血液灌流 双亲型吸附树脂 脓毒症 血液滤过 

分 类 号：R392[医药卫生—免疫学]