心脏瓣膜置换后的连续性静脉-静脉血液滤过

背景：心脏瓣膜置换后可发生机体免疫功能异常，但是关于连续性静脉-静脉血液滤过对心脏瓣膜置换后患者机体免疫功能影响的研究较少见报道。目的：观察连续性静脉-静脉血液滤过对心脏瓣膜置换后多脏器功能障碍综合征患者细胞免疫功能的影响。方法：2008年8月至2009年7月期间，收集解放军第四军医大学西京医院心脏手术后并发多脏器功能障碍综合征的患者31例，行连续性静脉-静脉血液滤过治疗，17例存活（存活组），14例死亡（死亡组）。另选取16例健康献血者作为对照组。结果与结论：存活组患者确诊急性肾衰竭后至开始连续性静脉-静脉血液滤过的时间明显短于死亡组（P ＜0.05）。在连续性静脉-静脉血液滤过治疗前，存活组和死亡组的CD4＋/CD8＋比值和Th1/Th2比值均低于健康对照组（P＜0.05），淋巴细胞凋亡率和淋巴细胞Fas/FasL抗原表达均高于健康对照组（P＜0.05），提示存在免疫抑制状态和Th1/Th2失衡。连续性静脉-静脉血液滤过治疗过程中，存活组患者24 h后CD4＋/CD8＋比值和Th1/Th2比值增加（P＜0.05），淋巴细胞凋亡率和和淋巴细胞Fas/FasL抗原表达降低（P＜0.05），而死亡组患者CD4＋/CD8＋比值、Th1/Th2比值、淋巴细胞凋亡率和和淋巴细胞Fas/FasL抗原表达与存活组有相似的变化趋势，但是较存活组出现更晚。说明连续性静脉-静脉血液滤过有助于改善心脏术后多脏器功能障碍综合征伴急性肾衰竭患者机体的细胞免疫功能，维持T淋巴细胞亚群间和Th1/Th2的平衡，下调淋巴细胞膜表面的Fas/FasL表达，减少淋巴细胞凋亡，早期行连续性静脉-静脉血液滤过可以改善患者的预后。

Continuous venovenous hemofiltration after cardiac valve replacement

BACKGROUND：Abnormal immunological function is possibly observed after cardiac valve replacement. However, effect of continuous venovenous hemofiltration on immunological function after cardiac valve replacement is rarely reported. OBJECTIVE：To observe the effect of continuous venovenous hemofiltration on the cellular immune function in patients with multiple organ dysfunction syndrome after cardiac valve replacement. METHODS：Thirty-one patients with multiple organ dysfunction syndrome after cardiac valve replacement in Xijing Hospital, the Fourth Military Medical University of Chinese PLA, from August 2008 to July 2009, were included in this study. They were treated with continuous venovenous hemofiltration using AV600 hemofilter and were divided into two groups：survival group （17 survivors） and death group （14 deaths）. In addition, 16 healthy blood donors served as the control group. 〈br〉 RESULTS AND CONCLUSION：The duration of acute renal failure before continuous venovenous hemofiltration of survival group was significantly lower than that of death group （P〈0.05）. Before continuous venovenous＆amp;nbsp;hemofiltration, the CD4＋/CD8＋ratio and Th1/Th2 ratio of survival group and death group were lower than that of control group （P〈0.05）, and lymphocyte apoptosis rate and Fas/FasL antigen expression were higher than that of control group （P〈0.05）. This evidence suggested the presence of immunosuppression state and Th1/Th2 disbalance. During continuous venovenous hemofiltration, the CD4＋/CD8＋ratio and Th1/Th2 ratio of survival group were gradual y increased （P〈0.05）, while lymphocyte apoptosis rate and Fas/FasL antigen expression were gradual y decreased （P〈0.05） at 24 hours. The above changes were observed in both survival group and death group, but emerged latter in death group. Continuous venovenous hemofiltration can improve cellular immune function, maintain the balance of T lymphocyte subsets and Th1/Th2, down-regulate Fas/FasL expression on the surface of lymphocyte membrane, and decrease lymphocyte apoptosis rate in patients with multiple organ dysfunction syndrome after cardiac valve replacement. Early continuous venovenous hemofiltration can improve patients’ prognosis.