高容量血液滤过对多器官功能障碍犬内毒素及CD14的影响

Effect of high volume hemofiltration on plasma endotoxin and CD14 in dogs with multiple organ dysfunction syndrome

目的观察高容量血液滤过（HVHF）治疗多脏器功能障碍综合征（MODS）犬中血浆内毒素（LPS）及其受体CD14的变化，探讨HVHF防治MODS的作用机制。方法12只Beale犬采用失血性休克＋复苏灌注＋内毒素血症建立MODS模型，随机（随机数字法）分为HVHF组（n=6）和MODS组（n=6），HVHF组在LPS注射完毕后给于HVHF治疗24h。分别于术前（T1）、LPS注射前（T2）、LPS注射完后0h（L），3h（T4），6h（T5），9h（T6），12h（T7），15h（T8）及24h（T9），观察血浆LPS及其受体CD14器官功能指标变化。LPS采用MB-80微生物快速动态检测系统测定。CD14采用ELISA测定。统计学方法各时间点前后采用重复测量资料方差分析。结果HVHF治疗后血浆LPS及CD14明显下降，在T4-9时间点明显低于MODS组（P〈0．01）。超滤液中能检测出CD14,SC为（0．81±0．09）。超滤液中未能检测出LPS。HVHF组主要器官功能明显改善，平均动脉压在T4-9时间点显著高于MODS组（P〈0．01）。动脉血氧分压逐渐升高，与MODS组在T4-9时间点比较差异有统计学意义（P〈0．01）。HVHF治疗后肌酐、尿素氮逐渐下降，与MODS组在T4-9时间点比较差异有统计学意义（P〈0．01）。结论HVHF能改善主要器官功能、降低血浆LPS及CD14峰值，有效遏制过度炎症反应。

Objective To explore the role of high volume bemofiltration （HVHF） in preventing and treating multiple organ dysfunction syndrome （MODS） by observing the alterations of plasma lipopolysaccharide （LPS） and its receptor CDj4. Methods Twelve Beagle dogs were subjected to hemorrhagic shock and injection of LPS to set up MODS model, and then dogs with MODS were randomly （random number） divided into two groups： HVHF group （n = 6） and MODS group （n =6）. HVHF was performed about 24 hours after LPS injection in MODS dogs of HVHF group. LPS, CD14 and organ function variables were determined before operation （T1）, before LPS injection （T2） and 0 h （T3） , 3 h （T4）, 6 h （T5）, 9h （T6）, 12 h （T7）, 15 h （T8） and24 h （T9） after LPS injected. The levels of LPS were determined by using rapid microbiological kinetic reader （MB-80）. CD14 was measured by using ELISA. Differences in LPS, CD14 and organ function at different intervals were evaluated by analysis of variance for repeated measures. Results Compared with the MODS group, plasma levels of LPS and CD14 were significantly decreased in the HVHF group at T4-9 （ P 〈 0. 01 ）. CD14 were detected in the ultrafiltrate, the sieving coefficients （SC） for CD14 were 0. 81 ± 0. 09. LPS could not be detected in the ultrafiltrate. The beneficial effect of HVHF on the hypotension in MODS model was particularly striking at T4-9 （P 〈 0. 01 ）. Mean arterial oxygen tension in HVHF groups at T4 -9 was significantly higher than that in MODS group （ P 〈 0. 01 ）. The levels of ereatinine and urea nitrogen were decreased significantly in the HVHF group compared with the MODS group at T4-9 （ P 〈 0. 01 ） Conclusions HVHF restrained excessive inflammatory responses by cutting clown the peak value of plasma LPS and CD14, improving the functions of major organs in MODS dogs.