高容量血液滤过对脓毒症患者可溶性髓样细胞触发受体1与血清降钙素原的影响

Effect of high-volume hemofiltration on sTREM-1 and PCT in patients with sepsis

目的探讨高容量血液滤过对可溶性髓样细胞触发受体1(sTREM1)、降钙素原(PCT)诊断危重症患者脓毒症的影响。方法将2008年5月至2012年4月在安徽省立医院ICU住院的脓毒症患者74例按照疾病严重程度分为两组:脓毒症组44例,严重脓毒症组30例。其中行高容量血液滤过患者40例。所有入选的74例脓毒症患者在入选当天和第5天行流式细胞术检测血中可溶性骨骨髓样细胞触发受体(sTREM1)、降钙素元(PCT)水平。比较脓毒症组、严重脓毒症组血中sTREM1、PCT水平变化。以及比较高容量血液滤过对脓毒症患者血中sTREM1、PCT的影响。同时选取20例健康人为对照组。结果脓毒症组sTREM1(288.9±30.5)、PCT为(9.72±2.59);严重脓毒症组sTREM1(310.5±51.7)、PCT为(13.42±5.12),严重脓毒症组较脓毒症组sTREM1和PCT明显升高,两组比较差异有统计学意义(P<0.05)。与常规治疗组比较,高容量血液滤过能更有效的降低脓毒症患者sTREM1和PCT的异常表达(P<0.05),纠正失控的炎症反应。结论脓毒症患者外周血sTREM1和PCT表达增加,随病情的加重,sTREM1和PCT水平进一步升高。高容量血液滤过可以调整失控的炎症反应,改善脓毒症患者的抗炎反应和致炎反应失衡。从而显著下调sTREM1和PCT的表达。

Objective To study the level and significance of sTREM-1 and PCT in peripheral blood of patients with sepsis and evaluate the effects of high volume hemofiltration（PHVHF） on them. Methods 74 patients with sepsis in ICU ofAnhui provicial hospital were studied from may 2010 to april 2012. Patients were divided into two groups： sepsis group（n=44）, severe sepsis group（n=30）. The expression of sTREM-1 and PCT of 74 patients on the day 1 and day 5 was detected. The comparision in the expression of sTREM-1 and PCT within groups was made. 40 patients receiving HVHF treatment .The effects of HVHF on the patients were evaluated .Twenty healthy individuals served as controls. Results The expression of sTREM-I and PCT was the higher in the severe sepsis group than in sepsis group （P〈0.05）. Compared with control group, our study indicated that high volume hemofiltration could decrease the abnormal expression of sTREM-1 and PCT more efficiency than routine treatment. Conclusion The expression of sTREM-1 and PCT was increased in sepsis patients and the level were correlate with the severity of sepsis,suggesting that they may play an important role in pathogenesis of sepsis. High volume hemofiltration could decrease their expression effectly. HVHF could rebuild inflammation balance so may be used as one treatment of regulating SIRS on sepsis patients.