摘要
目的 :探讨连续性血液净化 (CBP)对细胞因子的清除作用以及对血浆细胞因子水平影响的机制。 方法 :12例重症急性胰腺炎 (SAP)患者 (SIRS 6例 ,sepsis 6例 ) ,行连续性静脉 静脉高容量血液滤过(CVVHVHF) ,置换量 4 0 0 0ml/h ,均以前稀释方式输入 ,血流量 2 5 0～ 30 0ml/min ,连续进行 72h ,滤器为AN6 9膜 ,面积为 1 6m2 ,每 2 4h更换一次滤器及血路。在治疗初始 (0h) ,治疗后 2、6、12、2 4、4 8、72h ,取滤器前、滤器后抗凝血 ,同时留取滤液。分离单核细胞 ,用脂多糖 5 μg/ml刺激 12h ,留取上清液。EILSA法测定上清液、血浆及超滤液中细胞因子水平 (TNF α、IL 6、IL 10 )。 结果 :①在超滤液中仅能测及IL 6 ,滤过系数 (SC)为 0 0 881± 0 0 711,滤液中IL 6水平与血浆中水平呈正比 (r =0 4 6 37,P <0 0 0 1)。②三种细胞因子均能被滤器吸附 ,吸附量与血浆中水平成正比 (r =0 984 1,P <0 0 0 1,forIL 6 ;r =0 9394 ,P <0 0 0 1,forTNF α ;r =0 9398,P <0 0 0 1,forIL 10 ) ,滤器使用 12h后 ,吸附能力明显下降。清除总量约占同期血浆细胞因子水平的 16 %～ 2 3%。③治疗前 ,SIRS组患者血浆细胞因子水平明显升高 ,单核细胞分泌量明显增加 ,呈过度分泌状态。CBP治疗后 ,不论是血浆细胞因?
Objective:[STTo determine whether continuous veno-venous hemofiltration leads to extraction of pro-inflammatory cytokines including tumor necrosis factor-α(TNF-α), int erleukin-6 (IL-6) and anti-inflammatory cytokine IL-10 from the circulat ion of critical patients with severe acute pancreatitis, and its effect on plasm a cytokine concentrations. Methodology:Twelve patients with severe acute pancreatitis including 6 cases of SIRS and 6 o f sepsis were observed in this study. All of them underwent continuous high volu me veno-venous hemofiltration (CVVHVHF) for 72 hours using a polyacrylonotrile filter (1.6 m2, AN69). The ultrafiltrate rate was set at 4 000 ml/h and b lood flow at 250～300 ml/min; and the substitute fluid were infused with pre-di l ution. Hemofilter was changed every 24 hours. Blood were taken from the patients at 0, 2, 6, 12, 24, 48 and 72h during CVVHVHF. The ultrafiltrate were taken sim ultaneously. Peripheral monocytes were isolated and stimulated with LPS to detec t the ability of production of cytokines. The levels of TNF-α, IL-6 and IL-1 0 were tested by ELISA in the supernatant, ultrafiltrate and plasma. Results:① All of those cytokines were be adsorbed. After 12 hours using a new filter, t he adsorption was significantly decreased.② The major cytokine in the ultrafilt ration was IL-6, the SC of IL-6 was 0.0881±0.0711. The amount of IL-6 in t he untrafiltration had a positive correlation with the concentration in the plas ma (r=0.4637, P<0.001). ③After CVVHVHF treatment, the plasma cytokines' lev els in the most of the patients with SIRS were decreased, as same as the cytokin es' production of these patients. The plasma cytokines' levels in the most of th e patients with sepsis were no markedly changed, not as the status of cytokines' production. Conclusion:① Adsorption is the major method of cytokines' clearance. The ability of adsorp tion was gradually decreased when 12 hours used. All three cytokines can be adso rbed.② IL-6 was the major cytokine detected in the ultrafiltration. The amount of IL-6 in the ultrafiltration had a positive correlation with the concent ration of plasma. ③the levels of plasma cytokine were influenced by the balance of production and clearance of cytokines. CVVHVHF has an affect on both product ion and clearance of cytokines.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2004年第5期401-407,413,共8页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然科学基金课题 (No :3 0 47162 4)
