动态观察危重病人CRRT中COR,TNF-α,IL-6水平变化的临床意义

The Clinical Significance of Dynamic Observations on the Changes of Serum Cortisol (COR), TNF-α and IL-6 Levels in Critical Patients on Continous Renal Replacement Therapy (CRRT)

目的 :探讨危重病人连续性肾脏替代治疗 (CRRT)中动态观察血中皮质醇 (COR)、肿瘤坏死因子 (TNF-α)、白介素 - 6 (IL - 6 )水平变化的临床意义。方法 :把 2 7例病人于严重创伤后 12h有否进行CRRT随机分成CRRT治疗组和非CRRT治疗组 ,采用放射免疫分析 (RIA)检测两组患者在 12h、2 4h、4 8h、72h血中COR、TNF -α、IL - 6的含量 ,并观察患者体温 (T)、心率 (P)、呼吸 (R)等临床症状的改变。结果 :非CRRT治疗组COR、TNF -α、IL - 6水平呈进行性升高 ;CRRT治疗组TNF -α在CRRT治疗 12h ,显著低于同期非CRRT治疗组水平 (P <0 0 5 ) ,随后逐渐升高 ,但其水平仍较同期非CRRT治疗组低但无统计学意义 (P >0 0 5 ) ,而COR、IL - 6在CRRT治疗 12h后明显降低 ,组间有显著性差异 (P <0 0 0 1,P <0 0 5 ) ,治疗组临床症状显著改善。结论 :危重病人CR RT可明显降低COR、TNF -α、IL - 6水平 ,显著改善全身炎症症状 ,降低多脏器功能障碍综合征 (MODS)的发生率 ;动态观察COR、TNF -α、IL -

Objective To explore the clinical significance of the changes of serum levels of COR, TNF-α and IL-6 in critical patients on CRRT. Methods In this study, 13 critical patients (multiple trauma, major surgery, hemorrhagic pancreatitis etc.) had thier CRRT started within 12hrs after the respective event, other 14 critical patient of similar magnitade but without CRRT served as controls. Serum COR、 TNF-α and IL-6 levels were repeatedy detrmined with RIA at 12、 24、 48 and 72hrs after event in both groups. Changes of vital signs (T、 P、 R etc.) were noted at 24hr. Results Levels of COR、 TNF-α and IL-6 increased progressively in the group without CRRT. In the CRRT group, levels of TNF-α dropped after 12hrs on CRRT and were significantly lower than those in the group without CRRT (P<0.05). The TNF-α levels then rose gradually afterwards but remained lower than the corresponding levels in the non-CRRT group (although not significant, P>0.05). Levels of COR and IL-6 remained low or dropped continously in the CRRT group and were significantly lower than the corresponding levels in the non CRRT group (P<0.001,P<0.05). General conditions were much better in the CRRT group. Conclusion CRRT could reduce the serum contents of COR、 TNF-α and IL-6 in critical patients, which was helpful for abatement of SIRS and decrase of incidence of MODS. Dynamic determinations of these levels were useful for outcome prediction.