连续性静脉-静脉血液滤过对心脏瓣膜置换术后多脏器功能障碍综合征患者机体免疫功能和氧化应激的影响

目的 观察连续性静脉-静脉血液滤过（CVVH）对心脏瓣膜置换术后多脏器功能障碍综合征（MODS）患者机体免疫功能和氧化应激的影响.方法 31例心脏术后MODS伴急性肾衰竭（ARF）的患者使用AV600型聚砜膜血滤器行CVVH治疗,分别在治疗0、2、6、12、24和48小时取血,检测存活（A组）和死亡（B组）患者促炎因子肿瘤坏死因子（TNF）-α和白细胞介素（IL）-6]、抗炎因子（IL-10）、单核细胞人类白细胞（HLA）-DR抗原表达、过氧化指标丙二醛（MDA）]和抗氧化指标过氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-px）和血浆总抗氧化能力（TAC）]的变化.结果 （1）A组患者治疗前单核细胞分泌活跃,治疗后单核细胞分泌TNF-α、IL-6和IL-10均明显减少,B组患者则表现为分泌抑制状态,治疗后无明显变化;（2）与正常人比较,两组患者单核细胞表达HLA-DR明显降低;治疗后,A组患者明显改善,B组患者无改善;（3） CVVH治疗后,A组患者红细胞内MDA明显降低,SOD和GSH-px明显增高,而B组患者在整个治疗期间基本维持治疗前水平.结论 CVVH有助于改善心脏术后MODS患者机体的免疫功能状态和氧化应激损伤.

Effect of continuous venovenous hemofiltration on immune system and oxidative stress in patients with MODS after cardiac valve replacement

Objective To evaluate the effect of continuous venovenous hemofihration（CVVH） on inflammatory mediators and oxidative stress in survivors and uonsurvivors with multiple organ dysfunc- tion syndrome（MODS） after cardiac valve replacement. Methods Thirty one patients with MODS and acute renal failure （ARF） after cardiac surgery were treated with CVVH by using Avro0 hemofiher, they were divided into two groups： 17 survivors （group A） and 14 nonsurvivors（ group B）. The serum levels of proinflaramatory factor （ TNF-a, IL-6 ）, anti-inflammatory factor （ IL-IO ）, expression of mononuelear HLA-DR antigen, peroxidation factors including malondialdehyde （ MDA ）, superoxide dismutase （ SOD ） and total anti-oxidant capacity（TAC） were examined before and after the treatment for 2,6,12,24 and 48 hours. Results （1）Monocyte secretion was active in group A before the treatment, but after the treat- ment, TNF-ot,IL-6,IL-10 levels secreted by monocyte were decreased. Isehesis activity was showed in group B, and there was no significant changes after the treatment. （2）Compared with the health control, the expression of HLA-DR in monocyte was obviously lower in both groups. After the treatment, it im- proved significantly in group A, but not in group B. （ 3 ） MDA of erythrocyte in group A was degraded sig- nificantly after 2 h ,SOD and GSH-px increased significantly after 6 h and 12 h of the treatment respective- ly,but no changes were found in group B during the treatment period. Conclusion CVVH can improve the immunological function and oxidative stress damage in MODS including ARF after cardiac valve re- placement.