摘要
目的：探讨连续性肾脏替代治疗（ CRRT）对严重脓毒症患者调节性T细胞（ Treg）／辅助性T细胞（ Th）17平衡及其相关炎性因子IL-6、IL-10、IL-17、TNF-α的影响。方法选择60例严重脓毒症患者，按数字表法随机分为两组，各30例。对照组予常规治疗，观察组在对照组基础上加用CRRT治疗。采用流式细胞术检测Tregs、Th17细胞亚群水平；采用ELISA法检测外周血IL-6、IL-10、IL-17、TNF-α。同时，观察并记录APACHE II评分、ICU住院时间。结果治疗后，观察组APACHEⅡ评分、ICU住院时间均较对照组减低，组间比较差异均有统计学意义（t＝4．258、4．518，均P＜0．05）。观察组的Th17、Treg表达水平及Tregs／Th17均较对照组显著降低，组间比较差异均有统计学意义（t ＝5．872、4．267、4．285，均P＜0．05）。观察组IL-6、IL-17、TNF-α较对照组明显降低（t＝5．829、5．257、5．983，均P＜0．05）。但两组间IL-10表达水平均无明显改变[（35．26±18.63）pg／mL比（35．52±20．09）pg／mL，t＝2．164，P＞0．05]。结论 CRRT不仅能清除异常表达的炎性介质，改善T细胞功能，还能维持Treg和Th17的平衡，改善脓毒症的免疫紊乱，进而改善其预后。
Objective To investigate the effect of continuous renal replacement therapy （ CRRT） on the reg-ulation of Treg/Th17 in patients with severe sepsis,and related inflammatory factors IL-6,IL-17,IL-10,and TNF-α.Methods 60 patients with severe sepsis were randomly divided into two groups,30 cases in each group.The control group received conventional treatment,and the observation group was treated with CRRT on the basis of the control group.Flow cytometry was used to detect the levels of Tregs and Th17 cells,and IL-6,IL-10,IL-17 and TNF-αwere detected by ELISA method.At the same time,the APACHEII score,ICU length of hospital stay were observed and recorded.Results After treatment,APACHE Ⅱscore,ICU length of hospital of the observation group were lower than the control group,there were statistically significant differences（t=4.258,t=4.518,all P〈0.05）. The expression levels of Th17,Treg and Tregs/Th17 in the observation group were significantly lower than the control group,the differences were statistically significant （t=5.872,4.267,4.285,all P〈0.05）.The expression levels of IL-6,IL-17,TNF-αin the observation group decreased more significantly than the control group,the differences were statistically significant （t=5.829,5.257,5.983,all P〈0.05）.But the expression level of IL-10 in the two groups had no obvious change[（35.26 ±18.63） pg/mL vs （35.52 ±20.09） pg/mL,t=2.164,P〉0.05].Conclusion CRRT can not only remove the inflammatory mediators of abnormal expression,improve the function of T cells,but also can maintain the balance between Th17 and Treg,improve the immune disorders,and improve the prognosis of sepsis.
出处
《中国基层医药》
CAS
2016年第7期973-977,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市科技计划项目（Y20120227）
关键词
脓毒症
肾替代疗法
T淋巴细胞
Sepsis
Renal replacement therapy
T-lymphocytes
