连续性血液净化对脓毒症患者免疫及内皮细胞功能的影响  

Effect of continuous blood purification on immunity and endothelial cell function in patients with sepsis

作　　者：陈艳青 黄潇 刘晓立[1] 田焕焕[1] 吕冰洁[1] 孔桂青 宁方玉[1] 王涛[1] 郝东[1] Chen Yanqing;Huang Xiao;Liu Xiaoli;Tian Huanhuan;Lyu Bingjie;Kong Guiqing;Ning Fangyu;Wang Tao;Hao Dong(Department of Critical Care Medicine,Binzhou Medical University Hospital,Binzhou 256603,Shandong,China)

机构地区：[1]滨州医学院附属医院重症医学科,山东滨州256603

出　　处：《中华危重病急救医学》2023年第2期146-151,共6页Chinese Critical Care Medicine

基　　金：山东省高等学校科技计划项目(J12LL06)。

摘　　要：目的探讨连续性血液净化(CBP)对脓毒症患者免疫及内皮细胞功能的影响。方法采用前瞻性研究方法,选择2019年3月至2020年10月滨州医学院附属医院重症医学科收治的年龄≥18岁且符合脓毒症诊断标准的患者作为研究对象,按随机数字表法分为标准治疗组和CBP治疗组。两组患者均参照2016年脓毒症与脓毒性休克处理国际指南相关推荐给予初始液体复苏、控制感染源及应用抗菌药物等标准治疗;CBP治疗组在标准治疗的基础上给予连续性静脉-静脉血液滤过(CVVH),治疗剂量为25~30 mL·kg-1·h-1,血流速为150~200 mL/min,每天20 h以上,连续治疗3 d。分别于治疗前及治疗1 d、3 d记录患者的血乳酸(Lac)、降钙素原(PCT)、淋巴细胞计数(LYM)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评分(SOFA)等临床资料;取静脉血,采用酶联免疫吸附试验(ELISA)测定血清免疫功能相关指标〔白细胞介素(IL-4、IL-7)、程序性死亡受体-1(PD-1)、程序性死亡配体-1(PD-L1)、γ-干扰素(IFN-γ)〕及内皮细胞损伤相关指标〔可溶性血栓调节蛋白(sTM)、血管生成素-2(Ang-2)、血管性血友病因子(vWF)、硫酸乙酰肝素(HS)、多配体蛋白聚糖-1(SDC-1)〕水平;同时记录两组患者重症监护病房(ICU)住院时间,并随访患者28 d转归。结果最终入选标准治疗组患者20例,入选CBP治疗组患者19例;两组患者性别、年龄、感染部位差异均无统计学意义。标准治疗组ICU住院时间为(10±5)d;28 d死亡5例,存活15例。CBP治疗组ICU住院时间为(9±4)d;28 d死亡8例,存活11例。两组ICU住院时间和28 d死亡患者数差异均无统计学意义(均P>0.05)。两组患者治疗前及治疗1 d Lac、PCT、LYM、APACHEⅡ、SOFA评分及免疫功能和内皮细胞损伤相关指标差异均无统计学意义。治疗3 d时,CBP治疗组患者Lac、PCT及APACHEⅡ、SOFA评分均显著低于治疗前,同时IFN-γ和IL-4等促炎与抗�Objective To explore the effect of continuous blood purification(CBP)on the immunity and endothelial cell function of patients with sepsis.Methods A prospective study was conducted.The patients aged≥18 years old and meeting the diagnostic criteria of sepsis admitted to the department of critical care medicine of Binzhou Medical University Hospital from March 2019 to October 2020 were selected as the research subjects,and the patients were divided into standard treatment group and CBP treatment group according to random number table method.Both groups were given standard treatment including initial fluid resuscitation,infection source control and antibiotics according to the 2016 international guidelines for the management of sepsis and septic shock.CBP treatment group was additionally given continuous veno-venous hemofiltration(CVVH)at a dose of 25-30 mL·kg-1·h-1 and blood flow rate of 150-200 mL/min for more than 20 hours a day for 3 days.The clinical data of patients including blood lactic acid(Lac),procalcitonin(PCT),lymphocyte count(LYM),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score were recorded before treatment and 1 day and 3 days after treatment.At the same time,the venous blood was collected,and the immune function related indexes[interleukins(IL-4,IL-7),programmed death receptor-1(PD-1),programmed death ligand-1(PD-L1),interferon-γ(IFN-γ)]and endothelial cell injury related markers[soluble thrombomodulin(sTM),angiopoietin-2(Ang-2),von Willebrand factor(vWF),heparan sulfate(HS),syndecan-1(SDC-1)]levels in serum were determined by enzyme-linked immunosorbent assay(ELISA).The length of intensive care unit(ICU)stay of patients in the two groups was recorded,and the outcomes of patients in the two groups were followed up for 28 days.Results Finally,20 patients were enrolled in the standard treatment group,and 19 patients were enrolled in the CBP treatment group.There were no significant differences in gender,age and infection site betwe

关 键 词：脓毒症 细胞因子 内皮细胞 多糖包被 免疫调理 

分 类 号：R459.7[医药卫生—急诊医学]