配对血浆滤过吸附治疗多脏器功能障碍综合征对血清细胞因子水平影响的研究

目的研究配对血浆滤过吸附（coupled plasma filtration adsorption,CPFA）治疗重症感染并多器官功能障碍综合征（multiple organ dysfunction syndromes,MODS）患者对血清细胞因子的影响。方法选择重症感染并MODS的患者7例,采用前瞻性,随机,自身交叉对照研究。每例患者均在常规药物治疗基础上加用CPFA（A）和高容量血液滤过（B）（high volume hemofiltration,HVHF）各治疗10h,A,B治疗顺序随机,间隔一夜洗脱期（12h）,即A＋B或B＋A方案,比较两种治疗方式对七种血清细胞因子：肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-1β（IL-1β）、白细胞介素-10（IL-10）、白细胞介素-1受体拮抗剂（IL-1Ra）、可溶性肿瘤坏死因子受体1和受体2（sTNFR1、sTNFR2）的影响。结果①CPFA能明显降低血清TNF-α,升高IL-1Ra及sTNFR2/TNF-α、IL-1Ra/IL-1β的比值。10h与0h相比,均有统计学意义（P〈0.05）。HVHF中,血清IL-1β在5h时较0h有下降,至10h又恢复到0h水平;血清IL-1Ra、IL-1Ra/IL-1β比值在5h时上升,至10h又明显下降至0h的水平。CPFA、HVHF对血清细胞因子TNF-α、IL-1Ra、sTNFR2/TNF-α、IL-1Ra/IL-1β的影响有统计学意义（P〈0.05）;②CPFA0h,TNF-α、IL-1β、IL-6经过整个装置后的下降率分别为38.95%,41.76%,44.39%;5h时下降率分别降至23.55%,16.18%,7.53%。HVHF除在0hIL-1β经过血滤器的下降率为45.52%外,HVHF0h或5h以上细胞因子浓度在动、静脉端均无统计学意义（P〉0.05）。结论CPFA在降低致炎性细胞因子水平,提高抗炎/致炎因子比值方面,优于HVHF。提示CPFA治疗MODS有更广阔前景。

Effects of coupled plasma filtration adsorption on serum cytokines in patients with multiple organ dysfunction syndromes

Objective To investigate the effect of a novel extracorporeal blood purification therapy, coupled plasma filtration adsorption （CPFA）, on serum cytokines in multiple organ dysfunction syndromes （MODS） patients with severe infection. Methods This was a prospective, randomized and crossover clinical trial. A total of 7 patients diagnosed as MODS with severe infection were selected in this study. Patients were randomly allocated to both 1 Oh of coupled plasma filtration adsorption plus hemodialysis （CPFA, treatment A） and 1 Oh of high volume bemofiltration （HVHF, treatment B） with a 12h interval in between. The order of treatment A and B was randomly arranged, i.e., patients received treatment A＋B or B＋A randomly. Serum levels of seven inflammation mediators including tumor necrosis factor-α （TNF-α, interleukin-6 （IL-6）, interleukin-1 β （IL-1 β ）, interleukin-10 （IL-10）, interleukin-1 receptor antagonist （IL-1Ra）, soluble tumor necrosis factor receptor 1 and 2 （sTNFR1, sTNFR2） were measured at 0, 5, 1 Oh of each treatment. Results ①CPFA resulted in the decrease of serum TNF-α and the increase of serum IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL-1 β ratio （P 〈 0.05）. During HVHF, serum IL-1 β decreased at 5h and increased to baseline value at 10h, and serum IL-1Ra and IL-1Ra/IL-1β ratio increased at 5h and then decreased to baseline value at 10h. The changes of serum TNF-α, IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL- 1β ratio were different between treatment A and treatment B （P 〈 0.05）. ② During CPFA, serum TNF-α, IL-1 β and IL-6 were decreased by 38.95%, 41.76% and 44.39%, respectively, at Oh after flow through the aparatus; the 3 cytokines were decreased by 23.55%, 16.18% and 7.53%, respectively, at 5h. During HVHF, no changes of these cytokines were found between the arterial and venous ends of the hemofiltrator at Oh and 5h, except that serum IL-1β was decreased by 45.52% through the device at Oh. Conclusions CPFA was superior to HVHF in lowering proinflammatory mediators and increasing the ratios of anti-inflammatory mediators / pro-inflammatory mediators. Our findings suggest a potential role of CPFA in the treatment of MODS.