早期血液滤过对脓毒血症患者血浆IL-10和单核细胞人白细胞抗原-DR表达的影响

目的：探讨持续血液滤过开始时间对脓毒血症患者血浆IL-10和人白细胞抗原-DR表达的影响，评价血液滤过治疗效果。方法：选择本院ICU住院的40例脓毒血症患者，并按随机数字表法分为A组（早期血液滤过）和B组（晚期血液滤过）。在床旁持续血液滤过治疗开始后0h、12h、24h、48h、7d分别采集血液标本并检测细胞因子IL-10和单核细胞人白细胞抗原-DR（HLA-DR）的表达。结果：血液滤过治疗后，血液中细胞因子IL-10较治疗前均有下降，HLA-DR的表达也有所提高，与治疗前相比差异有统计学意义（P〈0.05）。但是A组与B组相比较，A组疗效优于B组（P〈0.05）。经治疗后，A组患者APACHEⅡ评分较B组明显降低。结论：血液滤过治疗能显著减少血浆中的抗炎细胞因子IL-10的表达，早期进行血液滤过治疗，能更好的改善预后，减轻患者的危重程度，这可能与患者血浆中HLA-DR表达上调有关。

The Impacts of Early Continuous Veno-venous Hemofiltration on IL-10 and Monocyte Human Leukocyte Antigen-DR Expression in Septic Patients

Objective：To investigate the impacts of early continuous veno-venous hemofiltration（CVVH）on plasma cytokines and monocyte human leukocyte antigen-DR（HLA-DR）expression and evaluate the relationship between them during CVVH treatment in septic patients. Method：Forty septic patients were enrolled in this study. They were randomly divided into group A（who received conventional treatment and CVVH treatment early in 48 h,n=20）and group B（who received conventional treatment and CVVH treatment 48h later,n=20）. The blood samples were taken to measure the changes of IL-10 and HLA-DR expression on monocytes. Result：After CVVH treatment,the plasma levels of IL-10 in septic patients markedly decreased（P〈0.05）. No matter early-treatment or later-treatment of CVVH,there was a negative correlation between plasma IL-10 and monocyte HLA-DR expression（P〈0.05）. HLA-DR expression on monocytes improved in early CVVH treated patients（P〈0.05）. Conclusion：Our findings suggest that CVVH be effective in removal of IL-10 and in improvement of monocyte HLA-DR expression in septic patients,and early CVVH in sepsis is better than later CVVH.