中国血液净化

›› 2009, Vol. 8 ›› Issue (9): 495-498.

• 论著 • 上一篇    下一篇

高容量血液滤过对多器官功能障碍综合征患者细胞免疫功能的影响

寇秋野 管向东 陈 雷 欧海燕 胡文利   

  1. 中山大学附属第六医院ICU，中山大学胃肠病学研究所;广州中山大学附属第一医院SICU
  • 收稿日期:2009-03-31 修回日期:1900-01-01 出版日期:2009-09-12 发布日期:2009-09-12

Effects of high volume hemofiltration on cellular immunity in patients with multiple organ dysfunction syndrome

KOU Qiu-ye, GUAN Xiang-dong, CHEN Lei, OU Hai-yan, HU Wen-li   

  1. 1ICU, Gastroenterology Institute, The Sixth Affiliated Hospital of Sun Yat-sen University; 2SICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655
  • Received:2009-03-31 Revised:1900-01-01 Online:2009-09-12 Published:2009-09-12

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摘要：

【摘要】目的 探讨高容量血液滤过(HVHF)对多器官功能障碍综合征(MODS)患者细胞免疫功能的影响。方法 选择MODS患者14例，行HVHF治疗, HVHF前和HVHF 1、3和5d分别取静脉血5ml，检测单核细胞计数，并且通过流式细胞仪检测CD3+、CD4+、CD8+、CD4+/CD8+、单核细胞HLA-DR水平的动态变化。 结果 14例患者存活 9例，死亡5例。存活组CD3+、CD4+、CD4+/CD8+值在HVHF治疗后较治疗前均有不同程度的升高，其中CD3+于HVHF5d与HVHF前相比有显著差异(P＜0.05)； CD4+、CD4+/CD8+于HVHF3d、5d与HVHF前相比显著升高(P＜0.05)； CD8+呈逐渐下降趋势，于HVHF3d、5d与HVHF前相比显著下降(P＜0.05)。死亡组CD3+、CD4+、CD4+/CD8+值在HVHF治疗后均有不同程度的升高，但与HVHF前相比均无统计学意义；CD8+在HVHF治疗前后呈下降趋势，但与HVHF前相比均无统计学意义。存活组外周血单核细胞计数和单核细胞HLA-DR表达在HVHF治疗后均呈升高趋势，与HVHF前相比，外周血单核细胞计数于HVHFld有显著差异(P＜0.05)，于HVHF3d、HVHF5d有非常显著差异(P＜0.01)；与HVHF前相比，单核细胞HLA-DR表达于HVHF ld有显著差异(P＜0.05)，于HVHF3d、HVHF5d有非常显著差异(P＜0.01)。死亡组外周血单核细胞计数、单核细胞HLA-DR表达在HVHF治疗前后无明显变化(P＞0.05)。 结论 HVHF可以调整MODS患者T细胞亚群比例，使单核细胞数目增加，单核细胞抗原提呈能力提高，改善MODS患者的免疫抑制状态

关键词: 高容量血液滤过, 多脏器功能障碍综合征, 细胞免疫

Abstract:

【Abstractt】 Objective To evaluate the effects of high volume hemofiltration (HVHF) on cellular immunity in patients with multiple organ dysfunction syndrome (MODS). Methods Fourteen MODS patients subjected to HVHF were enrolled in this study. Five mililiters of blood sample were collected from these patients before HVHF and after 1, 3 and 5 days of HVHF to count blood monocytes and to analyze lymphocyte subsets including CD3+, CD4+, CD8+ and the expression of HLA-DR on monocytes by flow cytometry. Results In the 14 patients, 9 patients survived and 5 died. In the survival patients after HVHF, the ratios of CD3+ and CD4+ and CD4+/CD8+ increased; CD3+ ratio increased significantly (P＜0.05) at the 5th day after HVHF, CD4+ and D4+/CD8+ ratios increased significantly (P＜0.05) at the 3rd and 5th days after HVHF, and CD8+ ratio decreased gradually and significantly (P＜0.05) at the 3rd and 5th days after HVHF. Additionally, blood monocytes count and the ratio of positive HLA-DR on blood monocytes increased at the 1st day after HVHF (P＜0.05) and significantly increased at the 3rd and 5th days after HVHF (P＜0.01). In the death patients after the treatment, however, no remarkable changes were found in the ratios of lymphocyte subsets, blood monocytes count and the ratio of positive HLA-DR on blood monocytes (P＞0.05). Conclusion HVHF may regulate the ratio of lymphocyte subsets, increase blood monocyte count, improve the antigen presenting function, and alleviate the immunosuppressive status in MODS patients.

Key words: Multiple organ dysfunction syndrome (MODS), Cellular