中国血液净化

›› 2005, Vol. 4 ›› Issue (5): 239-242.

• 论著 • 上一篇    下一篇

连续性血液净化治疗多器官功能障碍对机体免疫功能的影响

李 宓 杨 斌 杜 艺 彭 莉 邹和群   

  1. 5191000 珠海，中山大学附属第五医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-05-12 发布日期:2005-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-05-12 Published:2005-05-12

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摘要：

目的 观察连续性血液净化（CBP）治疗多器官功能障碍综合征(MODS)对机体免疫功能的影响。方法 20例多器官功能障碍综合征患者，CBP治疗72h。在治疗0、24、48、72h时，各取肝素抗凝血15ml，分离单核细胞，脂多糖（LPS）10mg/L（10μg/ml）刺激12h，ELISA法测定其分泌的细胞因子水平（TNF-α、IL-6、IL-10）；测定单核细胞人类白细胞DR抗原（HLA-DR）的表达情况判断其抗原呈递功能（流式细胞仪），同时观察外周血白细胞、单核细胞计数及血浆中各种细胞因子水平的变化。结果 20例患者在接受CBP治疗时，①单核细胞分泌功能：治疗前，单核细胞分泌活跃。治疗后，该组单核细胞分泌TNF-α、IL-6和IL-10均明显减少（ P<0.05）；②单核细胞抗原呈递功能：与正常人相比， MODS患者单核细胞表达HLA-DR都明显降低（ P<0.001）。治疗后，明显改善，（P<0.01）；③单核细胞数量：治疗前，与正常指标比较单核细胞数量均明显降低。治疗后，单核细胞数量明显上升接近正常水平。 CBP治疗后，血浆TNF-α和IL-6水平较治疗前明显降低(P<0.01）；④3例死亡患者 IL-10较其他患者明显升高，HLA-DR的表达则明显低下，CBP治疗后无明显改变。结论： ①CBP能明显改善多器官功能障碍综合征患者单核细胞功能，重建机体免疫系统内稳状态；②单核细胞HLA-DR表达及血浆IL-10水平是反映多器官功能障碍综合征患者机体免疫状态的一个良好指标。HLA-DR持续低表达和高血浆IL-10水平者预后差；③对免疫过度激化伴血浆细胞因子明显升高者，CBP显示了良好的清除效果。

关键词: 多器官功能障碍, 单核细胞, 血液净化

Abstract:

Objective To evaluate the effects of continous blood purification(CBP) on immune system in patients with multiple organ dysfunction syndrome (MODS). Methods Twenty patients with MODS, were enrolled in this study. All patients underwent CBP for 72 hours. The blood sample was collected from those patients at 0,24h,48h,and 72h during CBP. The monocytes in blood sample were isolated, and incubated with LPS at a concerntration of 10μg/ml for 12hrs at 37℃. The levels of TNF-α、IL-6 and IL-10 in the supernatants were determined by ELISA. The antigen presenting function represented by HLA-DR expression was detected by flow cytometry analysis.The number of cytokines secreted were evaluated in blood. Results ① The secretion function of monocytes: Before CBP, cytokines secreted from monocytes were higher than after CBP, there was a significant reduction of cytokines (TNF-α、IL-6、IL-10) secreted from monocytes after CBP (P<0.05); ② Compared with normal individuals, the HLA-DR expression on monocytes in MODS patients was significantly lower (P<0.01). After CBP the HLA-DR expression was significant improved;③ The number of monocytes :There was a significant decrease of the monocytes number compared with normal before CBP lower monocytes were ameliorated significant by CBP therapy. After CBP treatment, there was a significant reduction of plasma levels of TNF-α and IL-6 in MODS patients; ④ There was a significant increase of plasma level of IL-10 and significant decrease of HLA-DR expression in the 3 cases of died patients. After CBP, there weren't any improvement in the three cases of died patients. Conclusion: ① The abnormalities of immune system in patients with MODS can be improved after CBP therapy; ② The level of IL-10 and HLA-DR as indicators of immune system in MODS patients may be useful; ③ CBP therapy show significant affection in MODS patients with higher immune and higher secreted cytokines.

Key words: Monocyte, Blood purification

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