连续血液净化对重度脓毒症免疫调控的前瞻随机对照研究

Effect of Continuous Blood Purificatio on the Immunomodulation in Severe Sepsis Patients:a Prospective,Randomized,Controlled Clinical Trial

目的:探讨连续血液净化对重度脓毒症患者的免疫调控机制以及对于预后的影响。方法:选2004年6月至2007年10月收住ICU的18岁以上、Marshall评分>5分的重度脓毒症患者,随机分配入血液净化组和对照组;血液净化组:连续3d应用CRRT或MARS治疗,同时给予经典SSC治疗;对照组给予经典SSC治疗。结果:共有46例患者入选。与对照组同期比较,血液净化组治疗后d7APACHEII评分和MARSHALL评分以及IL-6、IL-6/IL-10和TNF-α均明显下降,而CD3+、CD4+、CD8+和HLA-DR均明显增高,差异有统计学意义。结论:连续血液净化具有双向调节脓毒症的免疫紊乱,减轻脓毒症患者的全身炎症反应,改善脓毒症患者的免疫抑制的作用。

Objective： To discuss the mechanism and effect of immunomodulation therapy on severe sepsis patients with continuous blood purification （CBP）. Method： Patients with severe sepsis at the ICU from Jun. 2004 to Oct. 2007 were randomly divided into two groups. The patients in control group were treated with classical SSC therapy , those in CBP group were treated with continuous renal replacement therapy （CRRT） or molecular adsorbents recirculating system （ MARS ） at the first 3 days. Result： Forty six patients were included in the study, compared with the control group , levels of CD^3＋ , CD^4 ＋ , CD^8 ＋ , HLA - DR in CBP increased significantly while the scores of APACHE Ⅱ ,Marshall and IL - 6, IL - 6/IL - 10, TNF - α were decreased significantly at the 8th -day. Conclusion： Continuous blood purification can decrease the blood concentration of cytokines on severe sepsis patients. The mechanisms include not only reducing the inflammatory mediators in the blood, but also bi -modulating the immune turbulence in the body.