急性胰腺炎患者血液滤过治疗后Treg/Th17平衡及细胞因子变化

Changes of Treg/Th17 balance and cytokines in patients with acute pancreatitis after hemofiltration

目的分析血液滤过治疗对急性胰腺炎(AP)患者调节性T细胞/辅助性T淋巴细胞17(Treg/Th17)平衡及细胞因子变化的影响。方法选择2019年4月-2021年4月开封市人民医院收治的AP患者65例,根据患者是否进行血液滤过治疗分为研究组35例,对照组30例。对照组予常规治疗,研究组在常规治疗的基础上予血液滤过治疗,检测两组患者入院第1天、第7天外周血Treg、Th17表达,计算Treg/Th17比值,比较两组血清淀粉酶(AMY)、脂肪酶(LPS)、降钙素原(PCT)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平、临床症状缓解时间及预后情况。结果入院第7天,两组患者外周血Treg、Treg/Th17升高,Th17、AMY、LPS、PCT、IL-6、TNF-α降低,且研究组入院第7天Treg、Treg/Th17高于对照组,Th17、AMY、LPS、PCT、IL-6、TNF-α低于对照组,差异均有统计学意义(P均<0.05)。与对照组相比,研究组患者腹痛、腹胀缓解时间、体温恢复正常时间、恶心呕吐消失时间及感染控制时间均较短,差异均有统计学意义(P均<0.05)。研究组入院第7天急性生理与慢性健康(APACHE-Ⅱ)评分、序贯器官功能衰竭(SOFA)评分低于对照组,差异均有统计学意义(P均<0.05),但两组随访90 d病死率比较差异无统计学意义(P>0.05)。结论采用血液滤过治疗AP感染,能够通过调节Treg/Th17平衡,改善血清细胞因子水平,清除机体炎症反应,缓解患者临床症状,减轻病情严重程度,但并未减少患者随访90 d病死率。

Objective To investigate and analyze the influence of hemofiltration on regulatory T cells/helper T cells 17(Treg/Th17)balance and cytokines in patients with acute pancreatitis(AP)infection.Methods A total of 65 patients withAP infection who were admitted to the Kaifeng People’s Hospital between April 2019 and April 2021 were selected.Theywere divided into study group(35 cases)and control group(30 cases).The control group received conventional treatment,and the study group was treated with hemofiltration on this basis.The expression of peripheral blood Treg and Th17 in thetwo groups was detected on day 1 and day 7 after admission,and Treg/Th17 ratio was calculated.The levels of serumamylase(AMY),lipase(LPS),procalcitonin(PCT),interleukin 6(IL-6),and tumor necrosis factorα(TNF-α),clinical symptom relief time and prognosis were compared between the two groups.Results On day 7 after admission,peripheral blood Treg and Treg/Th17 were increased,Th17,AMY,LPS,PCT,IL-6 and TNF-αwere reduced in the twogroups.Meanwhile,Treg and Treg/Th17 in the study group were higher than those in the control group,while Th17,AMY,LPS,PCT,IL-6,and TNF-αwere lower than those in the control group(all P<0.05).The relief time of abdominal painand distension,body temperature recovery,disappearance time of nausea and vomiting,and infection control time of studygroup were shorter than those of the control group(all P<0.05).The acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ)score and sequential organ failure assessment(SOFA)score of study group were lower than those of thecontrol group on day 7 after admission(all P<0.05).There was no statistically significant difference in 90 d mortality between the two groups(P>0.05).Conclusions Hemofiltration for AP infection could clear inflammatory response,alleviate clinical symptoms,and improve the patient’s condition through adjusting Treg/Th17 balance and improving serumcytokine levels.However,it could not reduce 90 d mortality.