持续静脉-静脉血液滤过治疗对早期严重脓毒症患者细胞免疫功能的影响

Effects of continuous venous-venous hemofiltration on cellular immune function in patients with early severe sepsis

目的前瞻性观察连续静脉-静脉血液滤过(CVVH)治疗对早期严重脓毒症患者细胞免疫功能及临床评分的影响。方法将78例早期严重脓毒症患者分为常规治疗组(32例)和CVVH组(46例),在相同常规治疗基础上,CVVH组加用CVVH治疗。分别于治疗前(0 h)和治疗后24 h、48 h抽取患者外周静脉血,应用流式细胞仪测定T淋巴细胞亚群(CD4^+、CD8^+细胞百分数及CD4^+/CD8^+比值),应用酶联免疫吸附法(ELISA法)检测血清TNF-α、IL-2和IL-4水平,记录患者同时间点急性生理与慢性健康状况评分(APACHEⅡ)及序贯性器官衰竭评分(SOFA)。结果 CVVH组患者在治疗后48 h的CD4^+细胞百分数(29.60±4.60)%及CD4^+/CD8^+比值(1.82±0.49)均较治疗前及常规治疗组明显升高(P<0.05),CD8^+细胞百分数(16.24±1.34)%及血清TNF-α(24.61±4.58)ng/m L、IL-2(216.35±35.52)ng/m L和IL-4(102.52±20.13)ng/m L水平均较治疗前及常规治疗组明显降低(P<0.05),APACHEⅡ评分(13.1±1.80)及SOFA评分(7.6±0.9)亦明显低于治疗前及常规治疗组水平(P<0.05)。结论 CVVH治疗可降低早期严重脓毒症患者血清促炎细胞因子表达水平,显著改善患者细胞免疫功能和临床评分,是临床治疗严重脓毒症的有效手段之一。

Objective To evaluate prospectively the effect of continuous venous-venous hemofiltration( CVVH) on the cellular immune function and clinical scores in patients with early severe sepsis. Methods Seventy-eight patients with early severe sepsis were randomized into control group( 32cases) and CVVH group( 46 cases). The patients in the control group were treated with conventional therapy,and the patients in the CVVH group received at least 48 hours CVVH treatment additionally.Peripheral blood were taken from the patients at 0 hours,24 hours and 48 hours during CVVH. The percentage of T lymphocyte( TC) subsets including CD4^+and CD8^+as well as the ratio of CD4^+/ CD8^+were respectively examined by flow cytometry,and the contents of cytokines released into supernatants were also determined by ELISA. The levels of APACHE Ⅱ and SOFA of patients were observed. Results At48 h after CVVH treatment,the percentage of CD4^+for( 29. 60 ± 4. 60) % and the ratio of CD4^+/ CD8^+for( 1. 82 ± 0. 49) were significantly increased compared with before treatment( P < 0. 05),and the levels of serum TNF-α for( 24. 61 ± 4. 58) ng / m L,IL-2 for( 216. 35 ± 35. 52) ng / m L and IL-6 for( 102. 52 ±20. 13) ng / m L were significantly decreased after the treatment( P < 0. 05). APACHE Ⅱ for( 13. 1 ± 1. 80)and SOFA for( 7. 6 ± 0. 9) scores were also significantly improved compared with before treatment( P <0. 05). Compared with the control group,all indices mentioned above were significantly improved at 48 hafter treatment in the CVVH group( P < 0. 05). Conclusion CVVH can improve the cellular immune function,maintain the balance of T lymphocyte subsets,and decrease the levels of inflammatory cytokines in patients with severe sepsis. Early CVVH can improve significantly patients' prognosis.