血液净化对脓毒症患者凝血功能及免疫功能的影响

目的:探究连续性血液净化(Continuous blood purification,CBP) 对脓毒症患者凝血功能及免疫功能的影响。方法:选取2012 年1 月至2015 年1 月入住新疆兵团第一师医院重症监护病房54 例符合脓毒症诊断标准的患者纳入本研究。采取CBP 治疗,分别在治疗前、治疗后12、24、48、72 h 时,对患者持续性观察,测定其APACHE域评分。收集患者不同CBP 治疗时间段的血液,利用流式细胞仪检测外周血免疫细胞CD4+ / CD8+ ,ELISA 法检测其分泌的细胞因子IL-1、IL-6、IL-10 和TNF-β,凝固法检测其凝血功能指标PT、APTT、TT,免疫比浊法检测FIB。结果:脓毒症患者治疗前PT、APTT、TT 和FIB 含量高于健康人群,具有统计学意义(均P<0.05) 。CBP 治疗12、24、48、72 h 的凝血功能指标PT、APTT、TT、FIB 相比CBP 治疗前显著降低(P<0.05)。脓毒症患者组的CD3+ 、CD4+和CD4+ / CD8+细胞频率较健康组明显降低(均P<0.05)。CBP 治疗12、24、48、72 h,相比治疗前,CD3+ T、CD4+ T 细胞频率逐渐升高(均P<0.05)。CBP 治疗12、24、48、72 h 的CD4+ / CD8+比例比治疗前显著升高(均P<0.05)。治疗前、CBP 治疗12、24、48 h 的CD3+ 、CD4+及CD4+ / CD8+细胞频率低于健康组(均P<0.05) 。CBP 治疗12、24、48、72 h 的IL-1、IL-6、IL-10 的水平较治疗前降低(均P<0.05)。CBP 治疗48 h、72 h 的TNF-β的水平较治疗前显著降低(均P<0.05)。治疗前、CBP 治疗12、24、48 h 的IL-1 的水平高于健康组(均P<0.05)。治疗前、CBP 治疗12、24、48、72 h的IL-6、IL-10 的水平高于健康组(均P<0.05)。治疗前、CBP 治疗12、24 h 的TNF-β水平显著高于健康组(均P<0.05)。CBP 治疗12、24、48、72 h 的APACHE域评分与治疗前比较均显著降低(均P<0.05)。结论:连续性血液净化能够通过清除血液中炎症因子,增强机体免疫功能,对改善脓血症患者的病情有一定帮助。

Effect of continuous blood purification on coagulation function and immune function in patients with sepsis

Objective:To explore the functions of continuous blood purification(CBP) on blood coagulation function and immune function of patients with sepsis.Methods: From January 2012 to January 2015,54 patients who were hospitalized in the intensive care unit(ICU) of the first division hospital of Xinjiang Crops that in accordance with the diagnostic criteria of sepsis were enrolled into this experiment.All the patients were treated with CBP,and their APACHE scores before treatment and 12 h,24 h,48 h and 72 h after treatment were measured with persistent observation,respectively.Blood were collected from patients in different times after CBP treatment.The peripheral blood immune cells (CD4+ / CD8),the levels of secreted cytokines (IL-1,IL-6,IL-10 and TNF-β),the coagulation function index (APTT,TT,PT) and FIB were detected by flow cytometry, ELISA,coagulation method and immunoturbi-dimetry,respectively.Results: The levels of PT,APTT,TT,and FIB of sepsis patients before CBP treatment were higher than those of healthy people (all P<0.05). Compared with before CBP treatment,the coagulation function indexes (PT,APTT,TT and FIB) were significantly reduced after CBP treatment for 12,24,48 and 72 h(all P<0.05).The frequencies of CD3+ ,CD4+ and CD4+ / CD8+ cells in the sepsis group were significantly lower than those in the healthy group (all P<0.05).After CBP treatment for 12,24,48 and 72 h,the frequencies of CD3+ T and CD4+ T cells were gradually increased when compared with those before CBP treatment (all P<0.05),while the CD4+ / CD8+ ratio was significantly higher than that before CBP treatment (all P<0.05).The frequencies of CD3+ ,CD4+ and CD4+ / CD8+ cells before CBP treatment and with CBP treatment for 12,24 and 48 h were lower than those in the healthy group (all P<0.05).After CBP treatment for 12,24,48 and 72 h,the levels of IL-1,IL-6 and IL-10 were lower than those before CBP treatment (allP<0.05).After CBP treatment for 48 h and 72 h,the levels of TNF-βwere lower than those before CBP treatment (both P<0.05).The levels of IL-1 before CBP treatment and with CBP treatment for 12,24 and 48 h were higher than those in the healthy group (all P<0.05),while the levels of IL-6 and L-10 before CBP treatment and with CBP treatment for 12,24,48 and 72 h were higher than those in the healthy group (all P<0.05).The levels of TNF-βbefore CBP treatment and with CBP treatment for 12 h and 24 h were higher than those in the healthy group (both P<0.05).After CBP treatment for 12,24,48 and 72 h,the APACHE score were significantly lower than those before CBP treatment (all P<0.05).Conclusion: Our study provide strong evidence that CBP is helpful to improve the condition and enhance immune function of patients with sepsis by removing inflammatory factors in blood.