高容量血液滤过治疗多器官功能衰竭犬对单核细胞功能影响的作用机制研究

The Mechanism of High Volume Hemofiltration in the Treatment of Multiple Organ Dysfunction Dogs on Monocytes Function

目的：观察高容量血液滤过（ HVHF）对多器官功能障碍综合征（ MODS）犬的单核细胞凋亡及抗原呈递功能、分泌功能以及外周血细胞因子的影响，探讨HVHF对单核细胞功能影响的作用机制。方法：通过二次打击建立MODS犬模型，随机分为HVHF组和MODS组。HVHF组给予HVHF治疗12 h，MODS组未给予HVHF治疗。监测两组实验动物外周血细胞、单核细胞凋亡及抗原呈递功能、单核细胞分泌功能的变化。结果：与MODS组相比，HVHF组在T5~7白细胞计数、中性粒细胞百分比明显下降，差异有统计学意义（ P〈0．05）；淋巴细胞百分比、单核细胞数及百分比呈升高趋势，尤其单核细胞数及百分比，HVHF组在T5~7显著高于MODS组（P〈0．01）。与MODS组相比，HVHF组在T2~7CD1＋4单核细胞早期、晚期凋亡率逐渐下降，差异有统计学意义（ P〈0．01）；HVHF组CD1＋4单核细胞DLA-DR表达呈上升趋势，在T5、T7时间点差异有统计学意义（P〈0．05）。与MODS组相比，HVHF组治疗后IL-4分泌明显升高，在T4~7差异有统计学意义（P〈0．01）。IL-1β分泌水平保持在较低水平，两组间相比差异无统计学意义。结论：本实验表明 HVHF 治疗可明显减缓单核细胞凋亡，使DLA-DR表达上升，有效改善单核细胞分泌功能，使机体恢复免疫平衡状态，降低机体损伤，从而使MODS得以缓解。

Objective：By observing the effects of high volume hemofiltration in the treatment of multiple organ failure dogs on the monocytes apoptosis,antigen presentation and secretion function,to investigate the mechanism of HVHF treatment effection on monocytes function. Methods：12 Beagle dogs used to establish the model and randomly assigned to MODS group（n=6）and HVHF group（n=6）,dogs in the MODS group received no treatment,HVHF group received HVHF treatment for 12 hours. Respectively be-fore operation（T1）,before endotoxin injection（T2）,at the end of endotoxin injection（0 h,T3）,3 h（T4）,6 h（T5）,9 h（T6） and 12 h（ T7 ）after the end of endotoxin injection. Apoptosis,DLA-DR expression,and cytokine levels were determined. Results：Results：CD1＋4 mononuclear cell early and late apoptosis began to decline gradually after HVHF treatment,there was significant differ-ence between two groups at T2~7（P〈0. 01）. After HVHF treatment,expression of DLA-DR showed a upward trend,compared with the MODS group ,there were significant differences at T5 and T7（P〈0. 05）. In HVHF group,IL-4 secretion increased significant-ly,compared with the MODS group,there are significant differences at T4~7（P〈0. 01）. Conclusion：HVHF can alleviate the mono-nuclear cell apoptosis,improve antigen presenting function and secretion function,control the inflammatory factors at an appropriate level,can better maintain the immune homeostasis,thereby effectively relieve MODS symptoms.