连续静-静脉血液滤过对全身性炎症反应综合征/脓毒症患者外周血高迁移率族蛋白-1水平的影响

目的 探讨连续静-静脉血液滤过治疗对全身炎症反应综合征(SIRS)/脓毒症(sepsis)患者外周血高迁移率族蛋白-1(HMGB-1)水平的影响.方法 对本院中心重症监护病房(ICU)全身炎症反应综合征(SIRS)/脓毒症(sepsis)患者(共30例),进行连续静-静脉血液滤过(CVVH)治疗,置换液均以前稀释40％、后稀释60％的方式输入,流量3L/h,血流量200 ～ 300 ml/min,治疗时间8h.分别留取CVVH治疗前(T0)、治疗开始后2 h(T1)、6 h(T2)、8 h(T3)及CVVH停止后12 h(T4)的右侧桡动脉血标本5ml,高速离心后取血清-20℃保存,同时留取CVVH 6 h滤液2 ml于-20℃保存备用,采用ELSIA方法检测动脉血清及滤液中HMGB-1的浓度,放射免疫法检测其中TNF-α及IL-6的浓度.结果 30例患者入院24 h内行CVVH治疗,其CVVH治疗时间为2～5(2.4±1.5)d,存活17例,死亡13例,病死率为43.3％.30例患者治疗后血清HMGB-1水平均有下降,与T0比较差异均无统计学意义[(11.88±6.06) ng/ml,(11.97±5.66) ng/ml,(11.94±5.94) ng/ml,(11.73±5.19) ng/ml vs (13.87±4.68) ng/ml,P＞0.05],治疗后各时点外周血清TNF-α及IL-6的水平均显著下降,与T0比较差异均有统计学意义[TNF-α:(0.28±0.15) ng/ml,(0.30±0.14) ng/ml,(0.29±0.19) ng/ml,(0.33 ±0.19) ng/ml vs(0.41 ±0.12) ng/ml,IL-6:(408.20 ± 92.18) pg/ml,(250.51±107.34) pg/ml,(276.00±126.20)pg/ml,(315.16±130.97) pg/ml vs(513.35±125.95) pg/ml,P＜0.05].结论 连续静-静脉血液滤过治疗能降低SIRS/SEPSIS患者外周血中HMGB-1浓度,可能是CVVH治疗脓毒症的作用机制之一.

Effect of continuous veno-venons hemofiltration on the peripheral blood levels of high mobility group box chromosomal protein 1 in patients with systemic inflammatory response syndrome or sepsis

Objective To investigate the effect of continuous veno-venous hemofiltration （CVVH） on the peripheral blood levels of high mobility group box chromosomal protein 1 （ HMGB-1 ） in patients with systemic inflammatory response syndrome （SIRS） or sepsis. Methods Thirty patients with SIRS or sepsis in Intensive Care Unit of our hospital were scheduled for treatment of CVVH. The replacement liquid was put in by the pattern of pre-dilution of 40% and post-dilution of 60%. The flow - rate was 3 L/h. The blood flow - rate was from 200 to 300 ml/min. 5 ml blood from right radial artery was got at the time points of pre- CVVH, CVVH 2 h, 6 h, 8 h and post-CVVH 12 h and the serum was stored at the temperature of -20 ℃ after high speed centrifugation, and 2 ml filter liquor was reserved at the time point of CVVH 6 h. The con- centration of serum and filter liquor HMGB-1 was measured by ELISA, but that of TNF-α and IL-6 were measured by radioimmunity. Results 30 patients adept CVVH therapy within 24 h to the hospital, and their therapy time was 2 - 5 （2. 4 ± 1.5 ）d. Among them, 17 cases survived and 13 cases died with a fatalityrate of 43.3%. Serum concentration of HMGB - 1 decreased from the baseline in patients, although this decrease was not statistically significant[ （ 11.88 ± 6. 06 ） ng/ml, （ 11.97 ± 5.66 ） ng/ml, （ 11.94 ± 5.94 ） ng/ ml, （ 11.73 ± 5.19 ） ng./ml vs （ 13.87 ± 4. 68 ） ng/ml, P 〉 0. 05 ] , Serum concentration of both TNF-α and IL-6 after therapy significantly decreased compared to the baseline in patients[ TNF-α： （0. 28 ± 0. 15 ）ng/ ml,（0. 30 ±0. 14） ng/ml, （0. 29 ±0. 19） ng/ml, （0. 33 ± 0. 19） ng/ml vs （0. 41 ± 0. 12） ng/ml, IL-6： （408.20± 92. 18 ） pg/ml, （ 250. 51 ± 107.34 ） pg/ml, （ 276. 00 ± 126. 20 ） pg/ml, （ 315. 16 ± 130. 97 ） pg/ml vs （513.35 ± 125.95 ） pg/ml, P 〈 0. 05 ]. Conclusions CVVH could decrease the concentration of HMGB-1 in peripheral blood, which would be one of the mechanisms of action for CVVH on sepsis.