连续血液净化对脓毒症患者炎症反应、免疫应答及靶器官损伤的影响

摘要

Objective: To study the effect of continuous blood purification on inflammatory response, immune response and target organ damage in patients with sepsis.Methods: A total of 78 patients with sepsis who were treated in the hospital between January 2015 and December 2016 were collected and divided into control group and observation group according to the random number table method, 39 cases in each group.Control group received conventional therapy for sepsis, and observation group received continuous blood purification on the basis of conventional therapy.The differences in inflammatory response, immune response and target organ damage were compared between the two groups before and after treatment.Results: Before treatment, difference in serum inflammatory factor contents, peripheral blood Th17/Treg cellular immunity levels and serum myocardial injury marker contents were not statistically significant between the two groups (P>0.05).After treatment, serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral blood Th17 and Treg cell levels and Th17/Treg proportion of both groups of patients were lower than those before treatment, and serum IL-2, IL-6, PCT, CRP, NT-prBNP, CK, CK-MB, TnT and TnI contents as well as peripheral blood Th17 and Treg cell levels and Th17/Treg proportion of observation group were significantly lower than those of control group (P<0.05).Conclusion: Continuous blood purification can effectively reduce systemic inflammatory response, inhibit immune response, and reduce myocardial injury in patients with sepsis.%目的:探讨连续血液净化对脓毒症患者炎症反应、免疫应答及靶器官损伤的影响.方法:收集2015年1月~2016年12月间在本院接受治疗的脓毒症患者78例,按照随机数表法分为对照组及观察组,各39例.对照组患者接受脓毒症常规治疗,观察组患者在常规治疗基础上加入连续血液净化治疗,对比两组患者治疗前后炎症反应、免疫应答及靶器官损伤的差异.结果:治疗前,两组患者血清炎症因子含量、外周血Th17/Treg细胞免疫水平、血清心肌损伤标志物含量的差异无统计学意义(P>0.05).治疗后,两组患者血清中白介素(IL)-2、IL-6、降钙素原(PCT)、C反应蛋白(CRP)、N末端脑利钠肽前体(NT-prBNP)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)、肌钙蛋白Ⅰ(TnI)以及外周血中Th17和Treg细胞水平、Th17/Treg比例均低于治疗前,且观察组患者血清IL-2、IL-6、PCT、CRP、NT-prBNP、CK、CK-MB、TnT、TnI以及外周血Th17和Treg细胞水平、Th17/Treg比例低于对照组患者(P<0.05),结论:脓毒症患者接受连续血液净化治疗,可有效减轻全身炎症反应、抑制不良免疫应答,减少心肌损伤.