摘要
目的:探究持续性高容量血液滤过(HVHF)对ICU重症急性胰腺炎(SAP)患者Th17/Treg失衡的影响。方法:选取2020年1月-2021年4月ICU收治的56例SAP患者为研究组,分为HVHF组(n=28)和非HVHF组(n=28)。另选取同期做健康体检的28例志愿者为对照组,提取外周血单个核细胞(PBMCs),采用流式细胞术检测Th17、Treg的百分率,采用酶联免疫吸附试验(ELISA)检测血清细胞炎症因子水平,并于治疗前、治疗24 h、48 h时评估急性生理与慢性健康评分Ⅱ(APACHEⅡ)及序贯器官功能衰竭评分(SOFA)。结果:研究组SAP患者Th17、Treg、Th17/Treg及血清IL-6、IL-10、IL-17、IL-23、转化生长因子-β(TGF-β)水平均显著高于对照组(P<0.05)。治疗12 h及24 h后,HVHF组患者Th17、Treg、Th17/Treg、IL-6、IL-10、IL-17、IL-23、TGF-β水平逐渐降低,与非HVHF组比较差异有统计学意义(P<0.05)。HVHF组患者在治疗24 h及48 h后APACHEⅡ评分、SOFA评分较基线值显著降低(P<0.05)。根据SAP患者在ICU住院期间死亡情况分为存活组(n=48)及非存活组(n=8),非存活组患者Th17、Treg、Th17/Treg、IL-6、IL-10、IL-17、IL-23、TGF-β基线值显著高于存活组(P<0.05)。经Spearman及Pearson分析,HVHF组患者基线Th17水平分别与IL-6水平及APACHEⅡ评分、SOFA评分呈正相关(r=0.525、0.347、0.286,P<0.001);基线Th17/Treg水平亦与血清IL-6水平及APACHEⅡ评分、SOFA评分呈正相关(r=0.402、0.389、0.265,P<0.001)。结论:HVHF治疗可在短时间内更好地消除炎症因子的过度分泌,纠正Th17/Treg失衡,进而有助于改善患者的预后。
Objective:To investigate the effect of continuous high-volume hemofiltration(HVHF) on the imbalance of IL-17-producing CD4T helper(Th17)/regulatory T(Treg) cells in intensive care unit(ICU) patients with severe acute pancreatitis(SAP). Methods:Fifty-six patients with SAP admitted to ICU of our hospital from January 2020 to April 2021 were selected as the study subjects, including HVHF group(n=28) and non-HVHF group(n=28). In addition, 28 volunteers who underwent health examination in our hospital during the same period were selected as the control group. Peripheral blood mononuclear cells(PBMCs) were extracted, the percentage of Th17 and Treg were detected by flow cytometry, and the levels of serum inflammatory cytokines were detected by enzyme linked immunosorbent assay(ELISA).The acute physiological and chronic health evaluationⅡ(APACHEⅡ) score and sequential organ failure assessment(SOFA) score were assessed before treatment and at 24 h, and 48 h of treatment. Results:Th17,Treg, Th17/Treg, IL-6,IL-10,IL-17,IL-23 and transforming growth factor-β(TGF-β) in patients with SAP were significantly higher than those in the control group(P<0.05).The levels of Th17, Treg, Th17/Treg, IL-6, IL-10, IL-17, IL-23 and TGF-β in HVHF group decreased gradually, and there was a significant difference between the HVHF group and non-HVHF group(P<0.05).The APACHE Ⅱ and SOFA baseline scores of patients in the HVHF group were significantly lower than the baseline value after 24 h and 48 h of treatment(P<0.05). According to the life-or-death situation of SAP patients during ICU hospitalization, the patients were divided into the survival group(n=48) and non-survival group(n=8). Th17, Treg, Th17/Treg, IL-6, IL-10, IL-17, IL-23,and TGF-β in the non-survival group were significantly higher than those in the survival group(P<0.05). Spearman and Pearson analysis showed that baseline Th17 level was a positive correlation with IL-6 level and APACHEⅡ and SOFA scores(r=0.525,0.347,0.286,P<0.001). Baseline Th17/Treg levels were posit
作者
詹师
杨召伍
陈山
ZHAN Shi;YANG Zhaowu;CHEN Shan(Department of Critical Care Medicine,Wenchang People's Hospital,Wenchang Hainan,571300,China)
出处
《临床急诊杂志》
CAS
2022年第7期486-493,共8页
Journal of Clinical Emergency
基金
海南省卫生计生行业科研项目(No:16A200034)。
