连续性血液净化治疗对重症急性胰腺炎患者血清细胞因子水平的影响

Effects of continuous blood purification on plasma cytokines in patients with severe acute pancreatitis

目的:探讨连续性血液净化治疗重症急性胰腺炎(SAP)时对血清细胞因子水平的影响及机理。方法:选择2007-06/2010-06本院收治的重症急性胰腺炎患者108例,按照是否接受连续性血液净化治疗分为常规治疗组50例和连续性血液净化治疗组58例,监测治疗前后病情及行动态急性生理和慢性健康(APACHEII)评分变化,并分别在治疗0、6、12、24、48、72h各时间点采用放射免疫法检测两组患者血清中TNF-α、IL-6、IL-10、IL-8水平的变化。结果:经72h治疗后,CBP治疗组患者在腹痛缓解时间、住院时间及并发症发生方面均明显优于常规治疗组,且CBP治疗组患者A-PACHEⅡ评分有显著改善,住院期间死亡病例明显低于常规治疗组,两组间比较有显著性差异(P<0.05),CBP治疗组患者血清TNF-α、IL-6、IL-10、IL-8水平均较治疗前明显降低(P<0.05),而常规治疗组患者在治疗72h内所有上述细胞因子水平均较治疗前无明显变化(P>0.05)。结论:CBP治疗能快速有效改善SAP患者病情,清除患者血清中过多的TNF-α、IL-6、IL-10、IL-8细胞因子,改善SAP患者临床转归,可成为治疗SAP的重要辅助措施。

AIM： To observe the effects of continuous blood purification （CBP） on plasma cytokines in patients with severe acute pancreatitis（SAP）. METHODS： 108 SAP Patients were chosen and divided into two groups： CBP treatment group and normal treatment group. Clinical symp- toms and APACHEII scores were tested pre-and post-treatment of continuous blood purification. The serum concentrations of cytokines were measured using specific enzymelinked immunosorbent assays at 0 h, 6 h, 12 h, 24 h, 48 h and 72 h post-treatment of continuous blood purification. RESULTS： After CBP treatment for 72 h, the duration of abdominal pain relief, the time of hospital and complications in CBP treatment group were better than those of normal treatment group. And APACHE II score were significantly improved in CBP treatment group . Compared with before treatment, plasma levels of TNF-α, IL-6, IL-I0, IL-8 in CBP treatment group decreased significantly after CBP treatment （ P 〈 0.05 ）, but those in normal treatment group don＇ t change. CONCLUSION： CBP treatment can effectively improve the prognosis of patients with SAP and decrease the production of cytokines. CBP may become an important therapeutic method for severe acute pancreatitis.