连续性血液净化治疗对创伤脓毒症患者外周血单核细胞膜型CD14表达及炎症反应的影响

Effect of continuous blood purification on peripheral blood monocyte membrane binding CD14 expression and inflammatory response in patients with traumatic sepsis

目的探讨连续性血液净化（CBP）治疗对脓毒症患者外周血单核细胞膜型CD14（mCD14）及炎症反应的影响。方法采用回顾性病例对照研究分析2015年1月-2016年12月收治的50例创伤后并发严重脓毒症患者临床资料，其中男34例，女16例；年龄16～73岁，平均45．37岁。根据是否同意接受CBP治疗，将患者分为CBP组（25例）和非CBP组（25例）。在两组治疗后0，12，24，48，72h留取外周血标本，采用流式细胞术检测mCD14水平变化，ELISA法检测白细胞弹性蛋白酶（HLE）表达变化。将治疗24h后的两组分离出外周血单核细胞并于体外培养，脂多糖（LPS）刺激后4，8，12，24，48，72h检测单核细胞中mCD14表达变化；采用ELISA法检测单核细胞培养液中肿瘤坏死因子-α（TNF-01）、白细胞介素（IL）-6及IL-10的水平。结果治疗后12，24，48，72h，两组HLE水平均较治疗前下调（P〈0．01），CBP组下调幅度明显大于非CBP组（P〈0．01）。治疗后12，24，48，72h，两组mCD14水平均较治疗前上调（P〈0．01），CBP组上调幅度明显大于非CBP组（P〈0．01）。CBP组在培养前及培养后4，8hmCD14水平明显高于相同时相点的非CBP组（P〈0．01）。两组单核细胞接受LPS再刺激后4，8，12，24，48h，CBP组TNF-α、IL-6的分泌水平均明显高于非CBP组（P〈0．01），而IL—10水平两组间差异无统计学意义（P〉0．05）。结论CBP治疗可以通过清除创伤脓毒症患者外周血炎症因子、促炎介质及直接或间接降低HLE水平，使其单核细胞mCD14水平上升，当机体再次受到外界刺激时，其抗炎反应能力明显强于未接受CBP治疗患者。

Objective To investigate the effect of continuous blood purification （CBP） on peripheral blood monocyte membrane CD14 （mCD14） expression and inflammatory response in patients with traumatic sepsis Methods A retrospective case control study was conducted on the clinical data of 50 patients with severe sepsis after trauma treated between January 2015 and December 2016. There were 34 males and 16 females, with an average age of 45.37 years （range, 16-73 years）. Patients were divided into CBP group （25 cases） and non-CBP group （25 cases） according to whether they agreed to receive CBP treatment. The peripheral blood samples were collected at 0, 12, 24, 48, and 72 hours after treatment, and the mCD14 and leukocyte elastase （HLE） expressions were detected by flow eytometry and by ELISA, respectively. The peripheral blood mononuclear cells were isolated from the two groups 24 h after treatment and cultured in vitro. The variations of mCD14 expression in mononuclear cells were measured at 4, 8, 12, 24, 48, and 72 h after stimulation with lipopolysaccharide （LPS）. The expression levels of tumor necrosis factor （TNF）-α, interleukin （IL）-6, and IL-10 in mononuclear cells were detected by ELISA. Results At 12, 24, 48, and 72 hours after treatment, the leukocyte elastase levels in the two groups were lower than those before treatment （P 〈0. 01 ）, and the decrease in CBP group was significantly greater than that of non CBP group（P 〈0.01）. At 12, 24, 48, and 72 hours after treatment, the mCD14 levels in both groups were up-regulated before treatment （ P 〈 0.01 ） , and the increase in CBP group was significantly greater than that of non CBP group （P 〈 0.01 ）. The mCD14 expressions before treatment, 4 h after treatment, and 8 h after treatment in CBP group were all higher than those in non CBP group at the same time points. At 4, 8, 12, 24, and 48 hours after the re-stimulation with LPS on the mononuclear cells in both groups, the levels of TNF-α and IL-6 in CBP group were significantly higher than those in non-CBP group （P 〈0. 01 ）, and there was no significant difference in IL-IO levels between the two groups （P 〉 0.05 ）. Conclusions CBP treatment can increase monocyte mCD14 expressions through eliminating inflammatory factors and pro-inflammatory mediators and reducing HLE directly or indirectly in patients with traumatic sepsis. When the body is stimulated again, its anti-inflammatory response ability is markedly stronger than that of patients who have not received CBP treatment.