摘要
目的:观察连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)患者的临床效果及其对免疫内稳状态的影响。方法:本文为前瞻性临床对照研究,12例男性SAP患者按随机原则分为Con组(常规治疗组,4例)和CBP治疗组(常规治疗+CBP治疗组,8例)。经72h治疗后对各组患者临床治疗效果进行比较(包括APACHE-Ⅱ评分及其它主要临床指标),同时在治疗0h、6h、12h、24h、48h和72h各时间点取血,动态观察SAP患者免疫内稳状态的变化,主要包括采用抗体芯片技术检测各组患者血浆细胞因子表达谱、Th1(促炎)/Th2(抗炎)细胞因子比例的变化,并观察治疗过程中单核细胞功能(HLA-DR表达)和单核细胞数目的变化。结果:(1)临床治疗效果比较:经72h治疗后,CBP组患者病情显著改善,血淀粉酶水平明显下降,肾功能恢复正常(P<0.05)。而Con组患者除血淀粉酶水平较治疗前有一定程度下降外,患者病情并无明显缓解,肾功能以及动脉血气等指标方面也无明显改善(P>0.05)。(2)免疫内稳状态指标的比较:除IL-4外,两组患者血浆中其它各种细胞因子水平均明显高于健康人群(P<0.05)。经72h治疗后,CBP组患者血IFN-γ,IL-1,IL-2和IL-5,IL-10,IL-13水平较治疗前明显降低(P<0.05);而血肿瘤坏死因子α(TNF-α)和IL-6水平虽较治疗前亦降低,但差异不具有统计学意义(P>0.05),IL-4水平则始终无明显变化。比值比提示经CBP治疗后SAP患者体内Th2类抗炎细胞因子IL-13、IL-10相对于Th1类促炎细胞因子IL-1、TNF-α水平下降显著。而且,经CBP治疗后,患者外周血单核细胞HLA-DR表达和单核细胞数目均较治疗前明显上升(P<0.05)。结论:CBP治疗除能快速有效改善SAP患者病情,纠正体内酸碱紊乱、清除体内代谢毒素外,还能清除体内过多生成的促炎和抗炎细胞因子,改善患者单核细胞抗原呈递能力,重建机体免疫系统内环境稳态,疗效明显优于传统疗法。经CBP治疗后SAP患者体内Th2类抗炎细胞因子IL-13、IL-10相对于Th1类促炎细胞因子IL-1、TNF-α水平下降显著,有利于改善患者体内的免疫抑制状态。
Objective ：To investigate the effects of continuous blood purification （CBP） on immune homostasis in patients with severe acute pancreatitis （SAP）. Methodology：Twelve SAP patients, all males, diagnosed as SIRS, were enrolled in this prospective cohort study. Among them, seven patients were proved to have bacteria infection. Those patients were divided into two groups randomly. They were control group （four patients who received conventional treantment） and CBP group （eight patients who received conventional treantment and CBP treatment for 72 hours）. The clinical prognosis was compared, and the blood samples were taken from those patients at 0, 6, 12, 24, 48 and 72hr during CBP to measure the levels of plasma cytokines profile with antibody chip. Meanwhile, effects of CBP treatment on peripheral monocytes, HLA-DR expression were also studied. Results： （ 1 ） After CBP treatment for 72hrs, APACHE-Ⅱ score and or-amylase in patients was significantly lowered than those before CBP, and renal function became recovery （ P 〈 0. 05 ）. While there was no marked improvement of patients in control group except that plasma or-amylase in these patients were lowered to some extents （P 〉 0. 05 ）. （2） Compared with healthy individuals, the plasma levels of cytokines in patients with SAP were great higher except for IL-4 （P 〈 0. 05）. After CBP treatment for 72hrs, the plasma levels of the IFN-γ, IL-1, IL-2 and IL-5, IL-10, IL-13 were markedly decreased, the levels of TNF-α and IL-6 were also reduced but without significant difference （P 〉 0. 05）. The ratio of IL-13/TNF-α and IL-13/IL-1 drop was lower than those before treatment. With CBP treatment, the HLA-DR expression and monocytes was markedly elevated （ P 〈 0. 05 ）, while the peripheral CD4^＋ /CD8^＋ T cells were increased insignificantly （ P 〉 0. 05 ）. In contrast, no change was shown in control patients, cytokines in some patients were even elevated a little. Conclusion：CBP treatment can not only effectively improve the prognosis of patients with SAP, ameliorate acid-base balance and remove metabolic waste, but also can decrease the production of cytokines, improve HLA- DR expression and restore immune homeostasis. After CBP treatment, IL-13/TNF-α and IL-13/IL-1 could be lower which suggests that the CBP clearance ability to Th2 cytokines is more effective.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2007年第4期308-315,共8页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然科学基金(30570703
30471624)
