联合应用血液灌流与血液透析对重症急性胰腺炎患者抑制性T细胞的影响及疗效

Hemoperfusion plus hemodialysis for severe acute pancreatitis:influence on suppressor T cells and efficacy

目的:观察联合应用血液灌流与血液透析治疗对重症急性胰腺炎(SAP)患者CD8+CD28-T细胞水平及全身炎症状态的影响。方法:选择2013年2月—9月收治的确诊为SAP的患者52例,随机均分为观察组和对照组。对照组接受常规治疗,观察组在常规治疗的基础上加用血液灌流联合血液透析治疗。比较两组治疗24 h后血清中CD8+CD28-T细胞、炎症因子、淀粉酶水平,以及两组临床症状恢复情况。结果:两组患者在治疗前的各项实验室指标差异均无统计学意义(均P>0.05);治疗24 h后,两组患者血清中CD8+CD28-T细胞水平、抑炎因子水平均明显升高,而促炎因子及淀粉酶水平均明显降低,但观察组所有指标的改善程度均优于对照组(均P<0.05);观察组临床症状恢复时间、胃肠功能恢复时间、住院时间均明显短于对照组(均P<0.05),两组体温恢复时间差异无统计学意义(P>0.05)。结论:联合应用血液灌流与血液透析治疗可有效提高SAP患者CD8+CD28-T细胞水平抑制全身炎症反应,加快病情恢复。

Objective： To observe the influence of hemoperfusion plus hemodialysis on CD8＋CD28- T cells and systemic inflammatory state in patients with severe acute pancreatitis （SAP）. Methods： Fifty-two patients who were admitted from February to September 2013 with confirmed SAP were selected, and equally randomized into observational group and control group. Patients in control group received routine treatment, while those in observational group underwent hemoperfusion plus hemodialysis in addition to receiving routine treatment. The serum levels of CD8＋CD28- T cells, inflammatory factors and amylase after 24-htreatment, and the recovery patterns of clinical symptoms between the two groups were compared. Results： There was no statistical difference in the laboratory parameters between the two groups before treatment （all P〉0.05）. After 24-h treatment, the serum levels of CD8＋CD28- T ceils and anti-inflammatory cytokines were significantly increased, while the levels of pro-inflammatory cytokines and amylase were significantly decreased in both groups, but all the degrees of improvement in all the parameters in observational group were greater than those in control group （all P〈0.05）. The time to disappearance of clinical symptoms and bowel function recovery, and the length of hospital stay in observational group were all shorter than those in control group （all P〈0.05）, while no statistical difference was found in the time for body temperature recovery between the two groups （P〉0.05）. Conclusion： Application ofhemoperfusion plus hemodialysis can effectively heighten the levels of CD8＋CD28-T cells and inhibit the systemic inflammatory response in SAP patients, and thereby accelerate the recovery of the patients.