连续性血液净化治疗对热射病患者组织因子的影响

目的：研究连续性血液净化（CBP）治疗对热射病患者组织因子的影响。方法：以34例热射病导致的多器官功能不全综合征（MODS）患者作为研究对象,所有患者行持续静脉血液滤过（CVVH）48h;以健康成人为对照。在治疗前以及CBP治疗各时间点,以ELISA法测定患者血清组织因子（TF）、可溶性血栓调节蛋白（sTM）、可溶性E选择素（sE-selectin）的水平,以流式细胞术测定单核细胞膜表面TF活性。用Pearson积差相关系数,研究血清TF与单核细胞膜表面TF活性、血清sTM以及sE-selectin的相关性。结果：与正常对照组比较,热射病患者血清TF、sTM和sE-selectin水平以及单核细胞膜表面TF活性明显增高（P〈0.01）。与治疗前比较,CBP治疗导致血清TF、sTM和sE-selectin水平、单核细胞膜表面TF活性明显下降（P〈0.05）。血清TF与单核细胞膜表面TF活性、血清sTM以及sE-selectin有显著相关性（P〈0.05）。结论：CBP可以通过抑制单核细胞和内皮细胞产生TF以及直接清除血清TF,达到降低血清中过度产生的TF作用。

The influence of CBP therapy on tissue factor in patience with multiple organ dysfunction syndrome induced by heat stroke

Objective：To investigate the influence of continuous blood purification（CBP）therapy on tissue factor（TF）in patience with serious heat stroke（HS）.Method：Thirty-four patients with multiple organ dysfunction syndrome（MODS）induced by HS were observed,and 10healthy people were selected as controls.All patients underwent continuous veno venous hemofiltration（CVVH）for 48hours.Before and during CVVH,serum concentrations of TF、soluble thrombmodulin（sTM）and soluble E-selectin（sE-selectin）were measured by ELISA,and the expression of membrane surface TF of mononuclear cells were detected by flow cytometry.Pearson analysis was applied to analyze the correlation between sTM、sE-selectin and expression of membrane surface TF of mononuclear cells.Result：Compared with normal controls,HS patients showed increased expression of serum TF、sTM and sE-Selectin（P〈0.01）.After CBP treatment,serum concentrations of TF、sTM and sE-Selectin decreased（P〈0. 05）.The expression of membrane surface TF of mononuclear cells were significantly higher than in normal controls before CBP treatment（P〈0.05）.After CBP treatment,the expression of membrane surface TF of mononuclear cells were significantly attenuated（P〈0.05）.The levels of TF correlated with sTM、sE-selectin and expression of membrane surface TF of mononuclear cells（P〈0.05）.Conclusion：CBP can suppress the serum concentrations of TF by inhibition the expression of TF in mononuclear cells and endothellal cells and removing the serum TF.