摘要
目的 :观察毒鼠强中毒患者免疫功能状态以及血液灌流联合连续性血液净化 (CBP)对毒素的清除及相应的免疫功能变化。 方法 :12例重度毒鼠强中毒患者行活性炭血液灌流 (HP)联合连续性静脉 静脉血液滤过 ,在治疗前 (0h) ,12h ,2 4h ,4 8h及 72h取抗凝血 ,分离单核细胞 ,细菌脂多糖 (LPS) 10 μg/ml刺激 12h ,测定其分泌的细胞因子水平 (TNF α、IL 6、IL 10 ) (ELISA) ,同时观察外周血单核细胞、淋巴细胞数量变化 ,并测定血浆中各种细胞因子水平。 结果 :①HP联合CBP治疗能显著降低血中毒鼠强浓度 (P <0 0 5 )。②与正常人相比 ,所有中毒患者单核细胞分泌的细胞因子明显减少 ,其中TNF α和IL 10 (P <0 0 1)为著。③HP联合CBP治疗后大多数患者临床表现明显改善 ,单核细胞分泌功能逐渐恢复正常 (P <0 0 5 )。少数患者单核细胞分泌功能则进一步减退 (P <0 0 5 ) ,并伴细胞数量明显减少 (P <0 0 1) ,这些患者血中毒鼠强浓度高 ,救治时间较晚 ,免疫功能处于严重抑制状态 ,患者预后极差。 结论 :①HP联合CBP治疗后 ,能快速、持续地清除毒鼠强 ;②与其他创伤、烧伤、炎症不同 ,毒鼠强中毒患者单核细胞免疫功能呈严重低下状态。随着毒素被清除 ,大多数患者免疫功能逐渐恢复 ,临床症状明显改善 ;
Objective:To investigate the immune status of the patients with severe tetramine poisoning and the effects of the sequential charcoal hemoperfusion (HP) and continuous blood purification (CBP) treatment on the immune status. Methodology:Twelve patients with severe acute tetramine poisoning were treated by sequential HP and continuous venovenous hemofiltration. Blood were taken from those patients at 0, 12, 24, 48 and 72 hours during CBP. Monocytes were isolated and incubated with LPS 10 μg/ml for 12 hours at 37℃. The levels of TNF α, IL 6 and IL 10 in the supernatants were detected by ELISA method to determine the secreting function of monocytes. The number of monocytes in peripheral blood was also counted at same time. The levels of plasma TNF α, IL 6 and IL 10 were examined simultaneously (ELISA). Results:① Compared with normals, the levels of cytokines secreted from monocytes of tetraminie poisoning patients were significantly lower, especially, the levels of TNF α and IL 10 ( P <0.01).② After HP combined CBP treatment, the concentration of tetramine in blood was decreased markedly( P <0.05), the outcome in most of the patients improved, simultaneously, and the function of monocytes was recovered in those patients( P <0.05). ③ Only in a few patients who failed to recover, the concentration of tetramine in blood was higher than those curing patients, the time from onset of poisoning to HP is later, and the immune status was severely suppressed and couldn't recover. Conclusion:The immune status is severely suppressed in patients with tetramine poisoning. Sequential hemoperfusion and CBP can eliminate the tetramine in blood significantly and persistently, and also improve monocyte function quickly in most of the patients. The prognosis of the poisoning patients is related with the dosage of toxin, the beginning time of treatment and the patient's immune status.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2003年第2期112-117,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
军队"十五"医学研究指令性课题 (NO :0 1L0 0 7)
