摘要
目的探讨连续性血液净化(continuous blood purification,CBP)治疗对脓毒症患者外周血白细胞弹性蛋白酶(HLE)及单核细胞表面脂多糖受体(mCD14)的影响及两者变化是否存在相关性。方法前瞻性病例对照研究分析2015年6月—2017年12月绍兴市人民医院收治的60例严重脓毒症患者,根据是否同意接受连续性血液净化治疗,将患者分为CBP组(30例)及对照组(30例)。在2组患者治疗过程的0、12、24、48、72 h时,留取外周血标本,采用ELISA法检测HLE表达量的变化,流式细胞术检测其mCD14水平变化,Pearson分析对CBP组HLE水平及mCD14表达量变化进行相关性分析。结果治疗后12、24、48、72 h时,2组患者HLE水平均较治疗前下调(均P<0.001),CBP组下调幅度明显大于对照组。治疗后12、24、48、72 h时,2组患者mCD14水平均较治疗前上调(均P<0.001),CBP组上调幅度明显大于对照组。CBP组HLE水平与mCD14表达量呈负相关(r=-0.644,P<0.001)。结论CBP治疗可以通过清除脓毒症患者外周血炎症因子、促炎介质等,直接或间接降低HLE水平,减轻其对单核细胞mCD14表达的影响,从而使患者机体免疫功能得到一定恢复,这也许是CBP参与重建机体免疫内稳状态的机制之一。
Objective To investigate the effect of continuous blood purification(CBP)therapy on peripheral blood leukocyte elastase(HLE)and monocyte surface lipopolysaccharide receptor(mCD14)in patients with sepsis and their correlation.Methods A prospective case-control study of 60 patients with severe sepsis admitted to the Department of Critical Care Medicine,Shaoxing People’s Hospital between June 2015 to December 2017 were enrolled and divided into CBP group(30 cases)and control group(30 cases)according to the implementation of continuous hemofiltration treatments.At the time of 0,12,24,48,and 72 hours after the treatment in both groups,the peripheral blood samples were collected,the changes of mCD14 were detected by flow cytometry,and the changes in expression of leukocyte elastase(HLE)was detected by ELISA.Correlation analysis of HLE Level and mCD14 expression in CBP group was made by Pearson software.Results At the 12 th,24 th,48 th,and 72 th hours after the treatment,the HLE levels in both groups were lower than those before the treatment(all P<0.001),and the CBP group was significantly lower than the Control group.At the 12 th,24 th,48 th,and 72 th hours after the treatment,the mCD14 levels in both groups were up-regulated as compared with the levels before the treatment(all P<0.001),while the CBP group was more significantly as compared with the control group.There was a negative correlation between HLE level and mCD14 expression in CBP group(r=-0.644,P<0.001).Conclusion CBP treatment can reduce the level of HLE by eliminating inflammatory factors and pro-inflammatory mediators,directly or indirectly,in patients with sepsis,as well as reduce its effect on monocyte mCD14 expression,so that the patient’s immune function will be restored to a certain extent.This probably may be one of the mechanisms for CBP to participate in the reconstruction of the immune homeostasis state.
作者
李智鑫
应利君
周蕾
孟东亮
席小龙
LI Zhi-xin;YING Li-jun;ZHOU Lei;MENG Dong-liang;XI Xiao-long(Department of Intensive Care Unit,Shaoxing People's Hospital,Shaoxing,Zhejiang 312000,China)
出处
《中华全科医学》
2020年第1期48-51,共4页
Chinese Journal of General Practice
基金
浙江省医药卫生科技计划项目(2015ZDA030)
绍兴市科技计划(医卫类)项目(2018C30062).
作者简介
通信作者:应利君,E-mail:yinglj6666@163.com.
