连续性血液净化治疗全身炎症反应综合征及脓毒症对机体免疫功能的影响

Effects of continuous blood purification on immune system in patients with SIRS/sepsis

目的 :前瞻性观察连续性血液净化 (CBP)治疗全身炎症反应综合征 (SIRS)及脓毒症 (sepsis)对机体免疫功能的影响。 方法 :12例急性重症胰腺炎 (SAP)患者 ,均符合SIRS标准 ,5例有明确感染证据 (sepsis组 ) ,7例无感染证据 (SIRS组 )。均行CBP治疗 72h。在治疗 0 ,2 ,6 ,12 ,2 4 ,4 8,72h时 ,各取肝素抗凝血 15ml,分离单核细胞 ,脂多糖(LPS) 10mg/L(10 μg/ml)刺激 12h ,ELISA法测定其分泌的细胞因子水平 (TNF α、IL 6、IL 10 ) ;测定单核细胞人类白细胞DR抗原 (HLA DR)的表达情况判断其抗原呈递功能 (流式细胞仪 ) ,同时观察外周血淋巴细胞、单核细胞计数及血浆中各种细胞因子水平的变化。 结果 :①两组患者在接受CBP治疗时 ,sepsis组处于病变晚期 ,病情重 ,并发症多。SIRS组处于病变早期 ,病情相对较轻 ,并发症少。在接受相同CBP治疗后 ,两组的预后不同 ,sepsis组较差 ,其平均住院天数明显较SIRS组长 (P <0 0 5 )。②单核细胞分泌功能 :治疗前 ,SIRS组单核细胞分泌活跃。治疗后 ,该组单核细胞分泌TNF α、IL 6和IL 10均明显减少 (P <0 0 5 )。而sepsis组则表现为分泌抑制状态 ,治疗后无明显变化。③单核细胞抗原呈递功能 :与正常人相比 ,两组患者单核细胞表达HLA DR都明显降低 (P <0 0 0 1)。治疗?

Objective:To evaluate the effects of continuous blood purification (CBP) on immune system in patients with systemic inflammatory reactive syndrome (SIRS)/sepsis Twelve patients, six males and six females, who diagnosed SIRS, were enrolled in this study Five of them had a positive culture regarded as sepsis group, and seven cases negative as SIRS group All of patients underwent CBP for 72 hours The blood was taken from those patients at 0, 2, 6, 12, 24,48 and 72hr during CBP The monocytes were isolated in blood, and incubated with LPS 10 μg/ml for 12 hrs at 37℃ In order to determine the secretion function of monocytes the levels of TNF-α, IL-6 and IL-10 in the supernatants were determined by ELISA The antigen presenting function represented by HLA-DR expression was detected by flow cytometry analysis Plasma TNF-α, IL-6 and IL-10 was tested simultaneously ① The time from onset of disease to receiving CBP treatment in the two groups was different Sepsis group was later than SIRS group( P <0 05) The condition of patients in the sepsis group was more severe than the SIRS group The complications of patients with sepsis were more complex than the SIRS group The time of hospitalization in the two groups was also different Sepsis group was longer than SIRS group( P <0 05) ② Before CBP, cytokines secreted from monocytes in SIRS group were higher than that in sepsis group ( P <0 05) After CBP, there was a significant reduction of TNF-a, IL-6 and IL-10 secreted from monocytes only in the SIRS group ( P <0 05) ③ Compared with normal individuals, the HLA-DR expression on monocyte in all patients was significantly lower ( P <0 0001), which was significantly improved with CBP therapy, especially in SIRS group ( P <0 001) ④ There was a significant decrease of monocytes in two groups of patients Those abnormalities were ameliorated significantly by CBP therapy ⑤ After CBP treatment, there was a significant reduction of plasma levels of TNF-α and IL-6 in SIRS group, but there was no significant difference in the two groups Plasma level of IL-10 was different in these two groups After CBP treatment, the plasma level of IL-10 in the SIRS group is not only significantly lower than that before treatment, but also significantly lower than that in the sepsis group ① The abnormalities of immune system in patients with SIRS/sepsis can be improved after CBP therapy, especially in the SIRS group ② The level of IL-10 and HLA-DR as an indicator to estimate the status of immune system and the severity of the disease may be useful ③ The time receiving CBP treatment is one of the most important factors influencing the effect of CBP treatment The earlier to receiving CBP treatment, the outcome is better