体外膜肺氧合联合持续肾脏替代治疗对健康小猪细胞因子表达的影响及意义

Effects of extracorporeal membrane oxygenation combined with continuous renal replacement treatment on cytokines in piglets

目的体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗的患者均会发生不同程度的全身炎症反应,而持续肾脏替代治疗(continuous renal replacement treatment,CRRT)可以清除各种炎性递质,文中通过观察ECMO联合CRRT对健康小猪细胞因子表达的影响,评估全身炎症反应程度,以期为临床生命支持治疗提供参考依据。方法以24只雌雄不限杂交健康小猪作为实验对象,随机分为对照组、假手术组、ECMO组、ECMO+CRRT组,每组6只,分别在实验前1 h、实验后2 h、6 h、12 h、24 h采集血标本,ELISA法测定血浆肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-6、IL-8、IL-10水平变化。结果各组实验前1 h TNF-α、IL-1β、IL-6、IL-8、IL-10无明显差异。实验后对照组及假手术组各细胞因子无明显变化;ECMO及ECMO+CRRT组促炎因子均呈明显升高趋势(与对照组比较,P<0.05),但ECMO+CRRT组各观察点升高水平均低于ECMO组。ECMO组抗炎因子IL-10变化呈先升高,后下降趋势,24 h接近对照组及假手术组;ECMO+CRRT组抗炎因子IL-10呈升高趋势,12 h后有回落,但仍维持在较高水平,与对照组比较差异有统计学意义(P<0.05),12 h、24 h与ECMO组比较有统计学意义(P<0.05)。结论 ECMO能使促炎细胞因子TNF-α、IL-1β、IL-6、IL-8释放增加,抗炎因子IL-10先升高后下降,导致组织损害及免疫内稳态失衡;ECMO联合CRRT治疗可减缓促炎细胞因子增加水平,同时提高IL-10水平。

Objective Extracorporeal membrane oxygenation （ECMO） can reduce mortality in critically-ill patients, but al- most all patients treated by ECMO develop a systemic inflammatory response syndrome （SIRS） characterized by a ＂cytokine storm＂, leukocyte activation, and multisystem organ dysfunction. We investigated the effects of ECMO and its combination with continuous re- nal replacement treatment （CRRT） on the plasma concentrations of inflammatory cytokines in piglets. Methods We randomly di- vided 24 piglets into four groups of equal number： control, sham, ECMO, and ECMO ＋ CRRT. We collected blood samples from the piglets 1 h before and 2, 6, 12 and 24 h after treatment, and determined the plasma levels of TNF-α, IL-1β, IL-6, IL-8 and IL-10 byELISA. Results There were no significant differences in the plasma levels of the cytokines before treatment, nor in the control and sham grouPs after it. The levels of TNF-α, IL-1β, IL-6 and IL-8 were increased after ECMO and ECMO ＋ CRRT, more significantly after ECMO than after ECMO ＋CRRT （P 〈0.05）. However, the IL-10concentration of the ECMO group first went up and then down, to the similar level of the control and sham groups at 24h, and it rose, too, in the ECMO ＋ CRRT group and maintained at a higher level though decreased a little at 12 h, with statistically significam differ- ences from the control group （ P 〈 0.05 ） as well as from the ECMO group at 12 and 24 h （ P 〈 0.05）. Conclusion ECMO can in- crease the release of proinflammation cytokines and attenuate anti-inflammatory cytokine, while its combination with CRRT can keep a balance between proinflammatory and anti-inflammatory cytokines in the body, and ameliorate ECMO related SIRS.