生物人工肾对急性肾衰并多器官功能障碍猪的细胞因子反应性及存活时间的影响

Bioartificial kidney alters cytokine response and survival time in acute uremic pigs with multiple organ dysfunction syndrome

目的探讨生物人工肾（BAK）对急性肾衰（ARF）合并多器官功能障碍（MODS）猪的细胞因子反应性及存活时间的影响。方法17只ARF并MODS猪模型随机分为三组：BAK组（A组，n=6）；假BAK组（B组，n=6），血滤器中不含细胞；未治疗组（C组，n=5）。观测平均动脉压、肝肾功能、血清IL-10、TNF-α、动脉血气和生存时间。两组计量资料的对比采用t检验；三组计量资料的比较采用方差分析。结果A组治疗24h平均动脉压（mmHg）显著高于B组、C组[（91．82±5．73）vs.（64．29±13．05）vs.（52．91±372），P〈0．01]。血清IL-10（pg／mL）的峰值A组明显高于B、C组[（249．57±43．51）vs．（132．06±17．53）vs．（104．25±13．42），P〈0．01]。血清TNF-α水平（pg／mL）A组治疗后较治疗前明显降低[（402．91±32．47）vs．（537．16±38．45），P〈0．05]；治疗24hA、B两组间亦有显著差异（P〈0．05）。生存时间：A组为（113．01±14．32）h，明显长于B组（83．14±17．68）h和C组（68.95±18．28）h（P〈0．01），A组比B、C组分别延长了35．93％、63．90％。结论BAK可明显延长MODS合并ARF猪模型的存活时间，可能与BAK显著改善其低血压状况、升高血IL-10水平和降低血TNF-α浓度有关。

Objective To study the effects of bioartificial kidney（BAK） treatment on cytokines interleukin-10（IL-10） and tumor necrosis factor-α（TNF-α）, biochemistry indexes, and survival time in acute uremic pigs with multiple organ dysfunction syndrome（ MODS）. Method Pigs with MODS and acute renal failure （ARF） were treated with BAK （group A, n = 6） or sham BAK containing no cells （group B, n = 6） or received no treatment （group C, n = 5）. Data on blood pressure, hepatic and renal functions, serum IL-10 and TNF-α levels, arterial blood gas and survival time of all the pigs were recorded. Comparisons of values were done using Student＇ s t -test or repeated-measures analysis of variance （ANOVA）. Results Mean arterial pressure （MAP, mmHg） responsed more rapidly and reached higher values in group A （91.82 ± 5.73） compared with group B and C at 24 hours （ P 〈 0.01）. The peak level of serum IL-10 （pg/mL） in group A （249.57 ± 43.51 ） was significantly higher than that in group B and C （132.06 ±17.53,104.25 ±13.42, P 〈0.01）. Serum TNF-α level （pg/mL） in group A dropped gradually to （402.91 ± 32.47） at 24 hours, and had significant discrepancy compared with that before the treatment （537.16 ±38.45） and that in group B （P 〈0.05）. The average survival time （hours） in group A（113.01 ±14.32） was significantly longer than that in the group B and C （P 〈 0.01 ）, which was prolonged by 35.93 % and 63.90 %, respectively. Conclusions Treatment with BAK can prolong the survival time of uremic pigs with MODS, possibly through ameliorating the MAP, increasing the level of IL-10 and reducing the concentration of TNF-α.