连续性血液净化对脓毒症患者免疫功能及预后的影响

Effect of continuous blood purification on immune function and prognosis in patients with severe sepsis

目的:探讨应用连续性血液净化(CBP)对脓毒症患者促炎/抗炎免疫功能及预后的影响。方法:将102例脓毒血症患者分为CBP组(60例)和常规治疗组(42例),在相同的常规治疗基础上,CBP组加用CBP治疗,持续治疗72 h。比较两组急性生理学与慢性健康状况评分系统(APACHE)Ⅱ评分和序贯器官功能衰竭(SOFA)评分;记录28 d生存率和重症病房(ICU)住院时间。分别于治疗前和治疗后24、48、72 h各时点抽取静脉血,应用流式细胞仪检测血中辅助性T细胞1/2(Th1/Th2)比值;酶吸附法测定白细胞介素-1(IL-1)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)。结果:治疗后CBP组APACHEⅡ、SOFA评分均下降(P<0.05)。两组28 d生存率差异无统计学意义(P>0.05),但CBP组ICU住院时间短于常规治疗组(P<0.05)。治疗72 h后,CBP组患者外周血IL-1、IL-10、TNF-α较治疗前明显下降,Th1/Th2较治疗前明显升高,与同期常规治疗组比较,差异均有统计学意义(P<0.05)。结论:CBP能通过清除炎症介质,增加机体的细胞免疫功能,恢复Th1/Th2的平衡,从而改善脓毒血症患者的总体病情。

Objective To investigate the effect of continuous blood purification （CBP） on pro-or anti-inflammatory immune function and prognosis in patients with sepsis. Methods One hundred and two patients withsepsis were randomized into the CBP group （60 cases） and the control group （42 cases）. The patients in the controlgroup were treated with conventional therapy, and the patients in the CBP group received at least 72 h CBP treatmentadditionally. The APACHE lI score, SOFA score, the 28 day survival rate and ICU length of stay were recorded andlevels of spleen Thl, Th2 were assessed by FACS flow cytometry. Enzyme linked immunoadsordent assay （ELISA）was used to determine the levels of serum IL-1, IL-10 and TNF-ct before and at 24, 48, 72 h after the treatment.Results The APACHE score and SOFA score decreased markedly in the CBP group after the treatment （P 〈0.05）. The period of staying in ICU of patients in the CBP group was shorter than that of patients in the control group（P 〈 0.05）. There was no significant difference of the 28 day survival rate between the two groups （91.6% vs71.2%, P 〉 0.05）. Compared with the control group, levels of IL-1, IL-IO and TNF-ot were decreased markedly,and the ratio of Thl/Th2 was increased significantly at 72 h after the treatment in the CBP group （P 〈 0.05）.Conclusion CBP can eliminate inflammatory mediators, and help to enhance the immune function, and restore thebalance of Thl/Th2 in patients with severe sepsis.