连续性高容量血液滤过中血清氨基酸水平对免疫功能的影响

EFFECT OF AMINOACID LEVEL DURING CONTINOUS HIGH VOLUME HEMOFILTRATION ON IMMUNE FUNCTION

目的:探讨连续性高容量血液滤过(CHVHF)治疗急性肾损伤(AKI)危重症患者中氨基酸水平的变化及其对免疫功能的影响。方法:选取接受24hCHVHF治疗的AKI危重症患者20例,随机分为CHVHF组和CHVHF+氨基酸组。观察单次治疗前后患者血清游离氨基酸谱、免疫球蛋白、淋巴细胞CD4+/CD8+比值、中性粒细胞吞噬率及吞噬指数的变化,同时评价急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分。结果:CHVHF治疗后,CHVHF组血清中所有氨基酸水平均降低,CHVHF+氨基酸组血清中所有氨基酸水平均较治疗前升高,多数氨基酸水平的差异具有统计学意义(P<0.05),CHVHF+氨基酸组7种必需氨基酸、谷氨酰胺、精氨酸水平均高于CHVHF组,差异具有统计学意义(P<0.05)。治疗后中性粒细胞吞噬率、吞噬指数及淋巴细胞CD4+/CD8+均较治疗前升高(P<0.05),CHVHF组低于CHVHF+氨基酸组,两组间差异具有统计学意义(P<0.05);治疗后两组免疫球蛋白均升高(P<0.05),但两组间差异无统计学意义(P>0.05);治疗后患者APACHEⅡ评分均降低(P<0.05),但两组间差异无统计学意义(P>0.05)。结论:在AKI危重症患者行CHVHF治疗过程中补充足够氨基酸可以提高患者血清游离氨基酸水平,进一步改善其免疫状态。

Objective： to investigate the effect of continuous high volume hemofiltration （CHVHF）on the changes of amino acid level in critical ill patients with acute kidney injury （AKI） and its influence on immune function . Methods：A total of 20 patients diagnosed with multiple organ dysfunction syndrome （MODS） company with AKI and would be recept CHVHF for 24 hours were selected in this study. They were randomly divided into CHVHF group and CHVHF＋AA group. Then, Serum free amino acid spectrum,immuneglobulin, lymphocyte CD4^＋/CD8^＋ , the phagocytosis rates and phagocytosis indexes of polymorphonuclear neutrophil （PMN）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） were measured before and after treatment in patients. Meanwhile, evaluating the score of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） . Results：The level of serum amino acids from CHVHF group was decreased after treated with CHVHF, but all the serum amino acids of CHVHF＋AA group were increased than that before treatment, expercially essential acid,such as glutamine, arginine, were significantly higer than the CHVHF group＇s（ P〈0.05） For Immunity function, thought it＇s found immunoglobulin was increased in serum after treatment, there was no difference in two group（ P〈0.05）. Furthermore, The increase ofphagocytosis rates, phagocytosis indexes of PMN and lymphocyte CD4^＋/CD8^＋ in CHVHGq-AA group was higher than the increase of phagocytosis rates, phagoeytosis indexes of PMN and lymphocyte CD4^＋/CD8^＋ in CHVHG group（ P〈0.05） Also. thought the Scores of APACHE Ⅱ （ P〈0.05） were decreased after the treatment, the difference between 2 groups was not statistically significant as well（ P〈0.05）. Conclusion： The supplement of amino acid during CHVHF might increase the serum free aminoacid concentration, and so improve the immune function of the critical ill patients.