连续性静静脉血液滤过治疗对外周血细胞因子的影响

EFFECT OF CONTINUOUS VENOUS-VENOUS HEMOFILTRATION ON THE CYTOKINES CONCENTRATIONS IN PERI-BLOOD

目的 研究连续性静 -静脉血液滤过 (CVVH)对外周血中肿瘤坏死因子 (TNF)、白细胞介素 1β(IL 1β)、白细胞介素 8(IL 8)和内皮衍生血管舒张因子 (一氧化氮 ,NO)浓度的影响。方法 10例重症急性肾功能衰竭 (AFR)患者在明确诊断后行CVVH ,每天持续 10～ 12h。采用中心静脉留置单针双腔导管建立血管通路 ,AK 10血泵建立体外循环 ,血滤器采用FH66D型 (聚酰胺膜 ,0 6m2 )。治疗前和治疗后 1、2、3、6、9和 12h(或结束时 )取血和超滤液检测TNF、IL 1β、IL 8和NO的浓度。结果 10例患者均存活且脱离血液滤过治疗。 4种细胞因子在超滤中均未能检出。CVVH开始 1h后外周血中TNF浓度轻度升高 ,但在治疗过程中缓慢降低 ,6h时达到最低水平 ,与治疗前和治疗 1h相比差异显著 (P <0 0 5 ,P <0 0 1) ,随后直到 12h时 ,其浓度基本稳定无显著变化 ;IL 1β水平在治疗后有下降趋势 ,6h降至最低值 ,但与治疗前相比差异不显著 ,6～ 12h间有所回升 ,IL 8浓度也呈同样变化趋势。NO水平在CVVH开始后亦缓慢降低 ,9h时达到最低值 ,但与治疗前相比差异不显著。结论 使用FH66D型血滤器行CVVH对各种细胞因子的清除效能不同 :治疗 6h时TNF水平显著降低 ,IL 1β ,IL 8和NO水平在治疗过程中无显著变化 ;

Objective To study the effect of continuous Venous-Venous h emofiltration on the concentrations of tumor necrosis factor, (TNF), interleukin -1β(IL-lβ), IL-8,and endothelium vasodilatatio factor nitrogen monoxide(NO) in peri-blood. Methods After final diagnosis, 10 patients s uffereing acute renal failure received CVVH, 10～12 hours a day. Mono-bullet do uble channels were detained in the center. venous to creat blood circuit. AK-10 blood pump and FH66D Polyamide membrane filter (0.6 m2) were used to build e xreacorporeal circulation. TNF, IL-1β,IL-8 and NO concentrations in the blood and ultrafiltrate were tested before the beginning of CVVH and l h, 2 h, 3 h, 6 h, 9 h and 2 h(or after the treatment) after. Results All pa tients were alive and out of CVVH. The four cytokines were not checked out in th e ultrafiltrate. The concentration of TNF steped-up lightly 1h after the beginn ing of CVVH but decreased slowly and reached its significant lowest level at 6h after the beginning. (958±469) ng/L verse (510± 711) and (1 552±662) ng/L, ( P<0.05 and 0.01, separately). IL-1β level declined after the beginning of the treatment, and reached its lowest level at 6 h after the beginning but th ere was no significant difference compared with that before the beginning. IL-8 level showed a similar changing tendency. NO level declined gradually after the beginning and reached its lowest level at 9 h after the beginning, but there wa s no significant difference compared with that before the beginning. Conclusions The clearance effect by CVVH with FH66D hemofiltr ation filter was different for different cytokins. TNF showed its significant lowe level at 6 h after the beginning of treatment, IL-1β, IL-8 and NO level showed no significant change during the treatment. Changing of filter at the ri ght moment might be helpful for the clearance of these cytokins.