摘要
目的探讨脉冲高容量血液滤过对脓毒症患者外周血辅助性T细胞（T helper，Th）17及CD4^＋ CD25A^＋调节性T细胞（Treg）影响及其临床价值。方法本研究为前瞻I生对照研究，将2008年1月至2010年11月在安徽省立医院ICU住院的脓毒症患者40例（男／女：24／16），年龄25～75岁，按照疾病严重程度分为3组：脓毒症组14例（男／女=8／6）；严重脓毒症组15例（男／女=9／6）；脓毒症休克组11例（7／4）。入选和疾病严重程度分级标准：根据1992年美国胸科医师学院（ACCP）／美国危重病医学会（SCCM）共识会议制定的脓毒症诊断标准。排除标准：患有自身免疫系统疾病、急性脑卒中、心肌梗死、病毒性肝炎、HIV感染的患者以及入院前3个月内使用过激素或免疫抑制剂的患者。其中入组5d内未行血液净化治疗患者15例（男／女=8／7）入选为A组；5d内行脉冲高容量血液滤过的25例患者（男／女=16／9）入选为B组，两组一般资料具有可比性。连续性血液净化以24 h为1周期，两次血滤之间间隔24 h。其中高容量血液滤过（70mL·kg^-1·h＾-1）治疗6～8h后续行常规CVVH治疗16～18h剂量（35mL·kg＾-1～·h＾-1）。所有入选的40例脓毒症患者在人选当天和第5天清晨空腹抽外周血送检，行流式细胞术检测血中Thl7细胞及CD＾＋’CD25＾＋调节性T细胞的比例。计量资料采用t检验，配对t检验和Oneway ANOVA分析。小样本率的比较采用确切概率法。相关分析采用Peason相关分析。另选取本院体检中心的20例健康人为健康对照组。结果健康对照组Thl7表达率为（0．91±0．38）％，CIM＾＋ CD25＾＋ Treg细胞表达率为（0．39±0．23）％。40例脓毒症患者在第1天这两项指标明显升高（P〈0．05）：其中脓毒症组分别为（2．09±0．53）％，（1．72±0．59）％；严重脓毒症组（3．90±0．80）％，（2．72±0．22）％；脓�
Objective To study the effects of pulse high volume hemofihration （PHVHF） on the changes of Thl7 cells （T helper 17 cells） and CD^＋ CD25^＋ reguratory T cells （Treg cells） in peripheral blood of patients with sepsis and to evaluate the clinical value of this intervention. Methods The patients were included in this prospective study as per the criteria of sepsis set by America Chest Physicians College/America Society for Critic Care Medicine in 1992. The patients were excluded： ①immune system disorder, ② acute stroke,③ myocardial infarction, ④ virus hepatitis, ⑤ human immunodefieiency virus infection, ⑥ under immunosuppressive therapy. Forty patients （24 males, 16 females, aged from 25 to 75years） with sepsis in ICU were enrolled from January. 2008 to November. 2010. According to the severity of disease, the patients were divided into three groups ： moderate sepsis group （ n = 14, 8 males, 6 females ） , severe sepsis group （n = 15,9 males, 6 females） , and septic shock group （n = 11,7 males, 4 females）. The initially clinical data of three groups were comparable. Twenty healthy individuals served as controls. According to the mode of treatment, forty patients were also divided into two groups ： conventional treatment group （group A, n = 15 ） in which patients were treated without PHVHF within 5 days after admission and trial group （group B, n =25） in which patients were treated with pulsed high volume hemofiltration （PHVHF） within 5 days after admission. In group B, high volume hemofiltration （70 mL · kg^-1 · h^-t ） was given to patients for 6 - 8 hours, and then conventional continuous vein - vein hemofiltration （35 mL · kg^-1 . h^-1 ） for 16 - 18 hours. The total length of period for continuum blood scavenging was 24 hours as one cycle. The interval between two cycles of blood scavenging was 24 hours. The changes of Thl7 cells and CD4^＋ CD25^＋ Treg cells of 40 patients were detected with flow eytometry on the l＇t day and the 5th day a
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2011年第6期604-609,共6页
Chinese Journal of Emergency Medicine
基金
安徽省卫生厅资助项目（09A079）
