摘要
目的研究不同的时机进行连续性肾脏替代治疗（CRRT）对多脏器功能障碍综合征（MODS）患者血清细胞因子及预后的影响。方法2008年7月至2010年10月江苏大学附属人民医院综合ICU收治并行CRRT治疗的MODS患者34例，根据患者发生MODS到进行CRRT治疗的时间为0～3d的归为早期组16例，4—10d的归为晚期组18例。两组MODS患者除CRRT治疗外，均给予常规治疗。两组患者在CRRT治疗前（0h）及治疗后6、12、18、24、48、72h测定血清6种细胞因子的水平：白细胞介素（IL）-1β、白细胞介素-1受体拮抗剂（IL-1Ra）、IL-6、肿瘤坏死因子（TNF）-α、可溶性肿瘤坏死因子受体1（sTNFR1）和IL-10，同时进行动态APACHEⅡ评分。结果（1）早期组在72h较0h血清IL-1β、IL-6、IL-10水平明显降低，IL-1Ra及IL-1Ra／IL-1β比值明显升高（P〈0．05）。晚期组血清IL-1β、IL-6、TNF-α、IL-10的水平的降低，IL-1Ra及IL-1Ra／IL-1β比值的升高，主要集中出现在最初的24h内（P〈0．05）。在72h早期组血清IL-10水平明显低于晚期组[（25±12）ng／L比（51±33）ng／L]（P〈0．05），而IL-1Ra及IL-1Ra／IL-1β比值明显高于晚期组[分别为（1382±899）ng／L比（683±188）ng／L，（54±10）比（23±6）]（均P〈0．05）。（2）早期组0hAPACHEⅡ评分明显低于晚期组（P〈0．05），早期组72hAPACHEⅡ评分较0h明显降低（P〈0．05），晚期组差异无统计学意义。两组0h脏器功能障碍数1〉4个的患者数差异无统计学意义，早期组7d脏器功能障碍数I〉4个的患者数较0h明显下降（P〈0．05），晚期组差异无统计学意义。结论调节抗炎／致炎因子的比值是CRRT调节免疫状态的关键，在MODS发生早期行CRRT治疗能够获得更大的临床收益。
Objective To explore the effects of continuous renal replacement therapy （CRRT） on serum cytokines and prognosis in multiple organ dysfunction syndrome （MODS） patients based on different therapeutic opportunities. Methods A total of 34 MODS patients in the treatment of CRRT after admission to ICU of our hospital between July 2008 and October 2010 were recruited. Based on the time interval from the onset of MODS to the initiation of CRRT, the patients were stratified into early group （0 - 3 days, n = 16） and late group （4 - 10 days, n = 18）. Both groups of MODS patients received conventional treatment in addition to 72 hours of high-volume hemofiltration （HVHF）. The serum levels of such inflammatory mediators as interleukin （IL） -1β, interleukin-1 receptor antagonist （ IL-1Ra）, IL-6, tumor necrosis factor （TNF）-α, soluble tumor necrosis factor receptorl （sTNFR1） and IL-10 were detected by enzyme linked immunosorbent assay （ELISA） before CRRT （0 h） and 6, 12, 18, 24, 48 and 72 h during the treatment of CRRT. Dynamic APACHE Ⅱ scores were also evaluated. Results （1） The early group had lower serum levels of IL-1β, IL-6, IL-10 and higher IL-IRa, L-1Ra/IL-1β ratio at 72 h than those of 0 h （P 〈0. 05）. And the late group had a declining serum level of IL-1 β, IL-6, TNF-α and IL-10 and a rising ratio of IL-1Ra and IL-1Ra/IL-1β during the first 24 h （ P 〈 0. 05 ）. As compared with the late group, the early group had a lower level of IL-10 [ （25 ±12） vs （51 ±33） ng/L] and higher ratios of IL-1Ra and IL-1Ra/IL-1βat72h [（1382±899vs （683±188） ng/L, （54±10） vs （23±6）] （bothP〈0.05）. （2） The early group had a lower APACHE Ⅱ score than the late group at 0 h （ P 〈 0. 05 ）. APACHE Ⅱ score at 72 h was significantly lower than 0 h in the early group. And there was no obvious change in the late group. There was no statistical difference in the numbers of MODS patients with dysfunctional organs number ≥ 4 at 0 h in both groups. The number of MODS patients with dysfunctional organs number ≥ 4 at 72 h was lower than 0 h in the early group （ P 〈 0. 05 ）. And there was no statistical difference in the late group. Conclusion Regulating the ratio of anti-inflammatory/pro-inflammatory mediators is critical in the immunomodulation of CRRT. And CRRT may provide more clinical benefits in the early phase （0 -3 days） of MODS.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第24期1663-1667,共5页
National Medical Journal of China
