连续性血液净化的免疫调节作用与脓毒症

Immunoregulation of continuous blood purification and sepsis

随着对脓毒症发病机制的深入研究,免疫功能改变、免疫动态平衡失调在脓毒症发病中的作用逐渐受到人们的重视。免疫调理治疗被认为是脓毒症治疗的一个希望所在。连续性血液净化(CBP)治疗能通过多种方式调节脓毒症的免疫功能,对改善脓毒症的预后有积极的作用。其可能的机制有:①通过滤过和吸附的机制,清除血浆中存在的可溶性炎性介质,减轻炎症介质对免疫细胞功能的直接抑制;阻断Th_1向Th_2的漂移;减轻淋巴细胞异常凋亡。②清除血中除炎症介质以外的其他毒性物质及某些致病因子。③抑制炎症系统与凝血系统的相互作用,阻断炎症级联。④纠正脓毒症患者内环境紊乱,改善组织氧合和心肺功能,重建机体免疫系统内稳状态等。因此,CBP的免疫调节作用在脓毒症的治疗中具有十分重要的研究和应用价值。

With the understanding of the pathogenesis of sepsis, it is known that the changes of immunologic function and immunologic dynamic dysequilibrium may play an important role in the develop- ment of sepsis. Immunomodulation therapy is considered as a new method to treat sepsis. Continuous blood purification （CBP） can modulate immunologic function of sepsis via several methods, and it could improve patients＇prognosis. The potential mechanisms are as follows：（1）It can eliminate the soluble inflammatory mediators by filtration and adsorption, and lessen the direct depression of inflammatory mediators to immunologic function; It also can block the shift of Th1 to Th2 and relieve the abnormal apoptosis of leu- kornonocyte. （2）CBP can also remove other toxic substances and some pathogenic factors; （3）It inhibits the interaction between inflamrnatory system and coagulation system, and blocks inflammatory cascade response. （4） It can rectify the disturbance of homeostasis, improve tissue oxygenation and cardiopulmonary function, and rebuild immunologic system. So, the imrnunornodulation of CBP play an important role in the treatment of sepsis, and can be beneficial to septic patients.