连续性血液净化及其联合血液吸附对多器官功能不全综合征患者细胞因子清除作用的比较

Cleaning effect of continuous renal replacement therapy or continuous renal replacement therapy plus blood absorption on cytokines in patients with multiple organ dysfunction syndrome

目的:探讨日间连续性血液净化(CRRT)联合血液吸附治疗对多器官功能不全综合征(MODS)患者细胞因子的清除作用。方法:37例MODS患者分为日间CRRT组(26例)及日间CRRT+吸附组(11例)。在治疗初始及3次治疗结束后取血,分离血清待检,同时每次治疗过程2、4、6、8h留取滤液待检。EILSA法测定血清及超滤液中细胞因子水平(TNF-α、IL-10)。结果:(1)治疗前,MODS患者血细胞因子水平明显升高。37例患者经治疗后5例好转。对病情好转的患者,接受血液净化治疗时APACHEⅡ评分均<20,两种治疗方法都可明显降低细胞因子水平。(2)37例患者经治疗后32例死亡,两组患者治疗前后血清中细胞因子水平无明显改变,但治疗后两组间细胞因子水平有明显差别,日间CRRT+吸附组明显低于日间CRRT组。(3)各时间点滤液中不能检测到细胞因子。(4)两种治疗方法的病死率分别为88.5%和81.8%。结论:(1)MODS患者TNF-α、IL-10等细胞因子水平明显升高。(2)两种治疗方法都有明显降低细胞因子的作用,且联合血液吸附对炎症因子的清除效果更好,不论是致炎或抗炎因子均能从循环中被清除。(3)虽然日间CRRT联合血液吸附加强了对炎症因子的清除,但与单纯日间CRRT相比,并没有增加其生存率。

Objective To determine the cleaning effect of continuous renal replacement therapy （CRRT） plus blood absorption on cytokines in patients with multiple organ dysfunction syndrome （MODS）. Methods 37 patients with MODS were assigned to receive CRRT （group A, n = 26） or CRRT plus blood absorption （group B, n = 11 ）. Cytokines [ tumor necrosis factor-alpha （TNF-α） and interleukin-10 （IL-10）] in blood serum, which was obtained before and 3 times after therapy, and in filtrate, which was obtained at 2, 4, 6, and 8 h during treatment, were detected by ELISA. Results Cytokines in serum in both of the two groups were decreased after therapy, and were lower in group B than in group A. 5 cases in the two groups received improvement （APACHE Ⅱ score 〈 20）, 32 cases died （APACHE Ⅱ score 〉 23）. Cytokines were negative in filtrate. Mortality rates in group A and group B were 88.5% and 81.8%, respectively. Conclusions Serum levels of TNF-α and IL-10 in patients with MODS are increased. CRRT can decrease serum levels of cytokines in patients with MODS, especially when combined with blood absorption. However, CRRT plus blood absorption can not reduce the mortality rates of MODS.