连续性肾脏替代治疗对急性坏死性胰腺炎炎症介质的改变

The Changes of Serum Cytokine Concentrations during Continuous Renal Replacement Therapy in Acute Necrotizing Pancreatitis Patients

目的研究连续性肾脏替代治疗（continous renal replacement therapy,CRRT）急性坏死性胰腺炎（acute necrotizing pancreatitis,ANP）前后外周血中肿瘤坏死因子α（TNF-α）、白细胞介素-8（IL-8）和内皮衍生血管舒张因子NO浓度的变化。方法对21例ANP患者明确诊断后立即行CRRT,10-12 h/d,血管通路采用股静脉置管14例,颈内静脉置管5例,临时周围动、静脉穿刺2例。采集治疗前（0 h）和治疗后1、6、12 h的动脉血检测TNF-α、IL-8和NO的浓度。结果 21例患者15例生存,6例死亡。TNF-α水平在治疗后1 h轻度升高,最后显著下降,6 h最低,6 h的浓度与0 h、1 h比较有显著差异（P〈0.05）;NO浓度在治疗后6 h显著降低,6 h、12 h与0 h比较有显著差异（P〈0.05）;IL-8浓度在治疗过程中无显著改变。结论 CRRT治疗ANP过程中清除炎症介质效果显著。

Objective To observe the changes in serum concentrations of tumor necrosis factor-α（TNF-α）,interleukin-8（IL-8） and nitric oxide（NO） during continuous renal replacement therapy（CRRT） in acute necrotizing pancreatitis（ANP） patients.Methods 21 ANP patients were treated with CRRT after diagnosis.CRRT lasted for 10 to 12 hours per day.Blood samples were collected before CRRT（0 h） and 1,6,12 h after CRRT.Results 15 patients survived and 6 patients died during the treatment.The TNF-α levels slightly elevated at 1 hour after CRRT,and decreased to trough level at 6 hour,which was significantly lower than the 0h and 1h,with（75.25±1.03） pg/ml of 6 h,（128.93±13.39） pg/ml of 0h and（150.4±21.05） pg/ml of 1h respectively.NO concentration significantly decreased at 6 h and 12 h（P〈0.05）,comparing with the 0 h.While the IL-8 concentrations were not apparently changed during the treatment.Conclusion The CRRT treatment can reduce the concentrations of the serum TNF-α,IL-8 and NO levels,which suggests that CRRT can improve the patients＇ outcomes.