连续性血液净化对多脏器功能障碍综合征患者血浆IL-1β,IL-6,IL-10影响

Effects of continuous blood purification on the plasma levels of IL-1β,IL-6,IL-10 in patients with multiple organ dysfunction syndrome

目的探讨连续性血液净化治疗(CBP)在多器官功能障碍综合征(MODS)中的应用及对血浆IL-1β,IL-6,IL-10的影响。方法选择符合MODS诊断标准的MODS患者42例,治疗组24例,予高容量连续性静脉-静脉血液滤过(HV-CVVH)模式治疗。于CBP前、CBP开始后4、12、24、48、72h留取血标本,采用ELISA法测定血浆IL-1β,IL-6,IL-10含量;治疗前,治疗后24、48、72h行慢性健康状况(APACHEⅡ)评分。对照组18例MODS患者,为同期病人或病人家属不愿意接受CBP治疗者,给予除CBP以外的常规治疗,在诊断后0、4、12、24、48、72h留取血标本。结果CBP治疗后治疗组24、48、72h的APACHEⅡ评分显著下降(P<0.05)。对照组治疗前后比较无显著性改变(P>0.05)。与CBP前比较,治疗组IL-1β,IL-6及IL-10明显下降(P<0.05),与对照组相比,在各时间点IL-1β,IL-6,IL-10下降有统计学差异(P<0.05)。结论过度的炎症反应是MODS发生的原因之一,CBP能够削弱血循环中炎症介质的峰值浓度,有效遏制过度的炎症反应,从而起到防治MODS的作用。

Objective To investigate the application of continuous blood purification and the affect to IL-1β,IL- 6,IL-10 in plasma in patients with multiple organ disorder syndrome（MODS）. Methods 42 patients met the criteria of MODS were divided into treatment group（24 cases） and control group（18 cases）. Patients in treatment group received CBP. High volume continuous venovenous hemofiltration（HV-CVVH）was performed. Plasma levels of IL-1β, IL-6 ,IL-10 were detected by enzyme linked immunosorbent assay（ ELISA） respectively before （baseline）and at 4.12. 24.48 h and 72h after CBP. APACHEⅡ score were recorded before （baseline）and at 24.48 h and 72h after CBP. At the same time to the patient or the patient＇s family are unwilling to accept the treatment of CBP eighteen patients in control group were treated with conventional therapy without CBP,and the blood samples were taken from those patients at 0,4.12,24,48 h and 72 h after diagnosis. Results IL-1β,IL-6 were significantly decreased compared with the baseline values before CBP （ P 〈0.05） ,While there was no significant change in the plasma levels of IL-10 at 4,12, 24and 48 h after CBP （ P 〉0. 05） ,APACHE Ⅱ score were significantly decreased after CBP（ P 〈0.05）. The levels of IL-1β,IL-6,IL-10and at 4,12,24.48 h and 72h after CBP in CBP group were lower than those in control group at according time（ P 〈0.05）. Conclusion Excessive inflammatory reaction may be the essential pathogenesis of MODS. CBP can cut down the peak concentration of inflammatory cytokines which can prevent and treat MODS through restraining excessive inflammatory reaction.