连续性血液净化对多脏器功能障碍综合征患者细胞因子和人类白细胞抗原表达的影响

Effect of continuous blood purification on plasma cytokines and expression of monocyte HLA-DR in patients with MODS

目的探讨连续性血液净化（CBP）对多脏器功能障碍综合征（MODS）患者细胞因子和人类白细胞抗原（HLA—DR）表达的影响。方法20例MODS患者，均符合MODS的诊断标准。经右侧股静脉置管，使用Diapact CRRT机以HV—CV—VH模式治疗。于CBP前、CBP后第一、三、五、七日晨分别应用ELISA法测定细胞因子，包括TNF-α、IL-1β、IL-2R、IL-6、IL-8、IL-4、IL-10；采用流式细胞仪测定单核细胞人类白细胞抗原-DR位点（HLA—DR）的表达。结果存活组在CBP治疗后血浆TNF-α、IL-1β、IL-2R及IL-8水平均逐渐降低（P〈0．05或P〈0．01），血浆IL-6、IL-4、IL-10水平在CBP治疗前后均无统计学差异（P〉0．05）；外周血单核细胞计数和单核细胞HIA—DR表达均呈升高趋势（P〈0．05或P〈0．01）。死亡组在CBP治疗前后血浆TNF-α、IL-1β、IL-2R、IL-8、IL-6、IL-4水平均无统计学变化，而IL-10在CBP 1d略有下降，后逐渐升高；外周血单核细胞计数早期呈升高趋势，后有所下降，与CBP前相比无统计学差异（P〉0．05）；单核细胞HLA—DR表达在CBP治疗前后无统计学变化。结论CBP可清除多种细胞因子，提高单核细胞HLA—DR的表达，从而改善MODS患者的免疫功能。

Objective To investigate the effect of continuous blood purification （CBP） on plasma cytokines and expression of monocyte HLA-DR in patients with MODS. Methods All of twenty patients met the criteria of MODS and were treated with CBP. Plasma levels of cytokines and expression of monocyte HLA-DR were detected. Results Survival group： Plasma concentrations of TNF-α, IL-1β, IL-2R and IL-8 decreased gradually, plasma levels of IL-6, IL-4 and IL-10 did not change significantly, and both the amount of monocyte and HLA-DR expression in peripheral blood increased after CBP. Non-survival group： There was no significant difference in plasma concentrations of TNF-α, IL-1β, IL-2R, IL-8, IL-6 and IL-4 between pre-CBP and post-CBP. Plasma level of IL-10 decreased at 1 st post-CBP day and then increased. No significant change was found in the amount of monocyte and expression of monocyte HLA-DR in peripheral blood after CBP. Conclusion CBP could remove some inflammatory cytokines from plasma and increase the expression of monocyte HLA-DR in patients with MODS.