中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2009年
1期
36-42
,共7页
王一梅%何建强%邹建洲%滕杰%丁小强
王一梅%何建彊%鄒建洲%滕傑%丁小彊
왕일매%하건강%추건주%등걸%정소강
血液滤过%休克,脓毒性%肿瘤坏死因子α%白细胞介素10%急性肾损伤
血液濾過%休剋,膿毒性%腫瘤壞死因子α%白細胞介素10%急性腎損傷
혈액려과%휴극,농독성%종류배사인자α%백세포개소10%급성신손상
Hemofiltration%Shock,septic%Tumor necrosis factor-alpha%Interleukin-10%Acute kidney injury
目的 探讨不同剂量连续性血液滤过(CVVH)对细胞因子的清除作用以及对血浆细胞因子水平的影响.方法 采用静脉注射内毒素(E.coli O111:B4,15.7 μg/kg)的方法诱导内毒素休克猪模型.将内毒素休克猪按随机数字表法分为对照组(n=6)、CVVH组(n=6,前稀释法,等于后稀释法的45 ml·kg-1·h-1)和高容量血液滤过(HVHF)组(n=6,前稀释法,等于后稀释法的70 m1·kg-1·h-1).于造模前(基线)、成模时(TO),成模后1 h(T1)、6 h(T6)、12 h(T12)、24 h(T24)分别测定血浆肿瘤坏死因子α(TNF-α)、白细胞介素(IL)6、IL-10和IL-18水平.结果 对照组动物平均生存时间为(15.4±5.2)h;CVVH组为(21.4±7.1)h;HVHF组为(22.4±6.7)h,CVVH组和HVHF组的生存时间显著高于对照组(均P<0.05).3组动物的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)和心排出量(CO)之间差异无统计学意义(P>0.05).内毒素休克猪成模后出现BUN和Scr的进行性升高,两治疗组的BUN和Scr水平显著低于对照组(P<0.05),但两者之间差异无统计学意义(P>0.05).对照组TNF-α和IL-6水平在T1时达高峰,IL-10水平在TO时最高,随后不断下降.IL-18水平在成模后上升,后无明显变化.CVVH组血浆IL-10(T6、T12、T24)水平低于对照组(P<0.05).HVHF组TNF-α(T6)和IL-10(T6、T12、T24)水平低于对照组和CVVH组(P<0.05),3组的IL-6和IL-18水平差异无统计学意义,IL-6(T6、T12)水平和动物生存时间呈负相关(P<0.05).结论 CVVH和HVHF治疗均能显著延长内毒素休克猪的生存时间.CVVH能有效清除IL-10;HVHF治疗能清除TNF-α和IL-10;但CVVH和HVHF对IL-6和IL-18水平无明显影响;CVVH和HVHF均能有效清除BUN和Scr.IL-6水平是预测内毒素休克预后的独立指标.
目的 探討不同劑量連續性血液濾過(CVVH)對細胞因子的清除作用以及對血漿細胞因子水平的影響.方法 採用靜脈註射內毒素(E.coli O111:B4,15.7 μg/kg)的方法誘導內毒素休剋豬模型.將內毒素休剋豬按隨機數字錶法分為對照組(n=6)、CVVH組(n=6,前稀釋法,等于後稀釋法的45 ml·kg-1·h-1)和高容量血液濾過(HVHF)組(n=6,前稀釋法,等于後稀釋法的70 m1·kg-1·h-1).于造模前(基線)、成模時(TO),成模後1 h(T1)、6 h(T6)、12 h(T12)、24 h(T24)分彆測定血漿腫瘤壞死因子α(TNF-α)、白細胞介素(IL)6、IL-10和IL-18水平.結果 對照組動物平均生存時間為(15.4±5.2)h;CVVH組為(21.4±7.1)h;HVHF組為(22.4±6.7)h,CVVH組和HVHF組的生存時間顯著高于對照組(均P<0.05).3組動物的心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)和心排齣量(CO)之間差異無統計學意義(P>0.05).內毒素休剋豬成模後齣現BUN和Scr的進行性升高,兩治療組的BUN和Scr水平顯著低于對照組(P<0.05),但兩者之間差異無統計學意義(P>0.05).對照組TNF-α和IL-6水平在T1時達高峰,IL-10水平在TO時最高,隨後不斷下降.IL-18水平在成模後上升,後無明顯變化.CVVH組血漿IL-10(T6、T12、T24)水平低于對照組(P<0.05).HVHF組TNF-α(T6)和IL-10(T6、T12、T24)水平低于對照組和CVVH組(P<0.05),3組的IL-6和IL-18水平差異無統計學意義,IL-6(T6、T12)水平和動物生存時間呈負相關(P<0.05).結論 CVVH和HVHF治療均能顯著延長內毒素休剋豬的生存時間.CVVH能有效清除IL-10;HVHF治療能清除TNF-α和IL-10;但CVVH和HVHF對IL-6和IL-18水平無明顯影響;CVVH和HVHF均能有效清除BUN和Scr.IL-6水平是預測內毒素休剋預後的獨立指標.
목적 탐토불동제량련속성혈액려과(CVVH)대세포인자적청제작용이급대혈장세포인자수평적영향.방법 채용정맥주사내독소(E.coli O111:B4,15.7 μg/kg)적방법유도내독소휴극저모형.장내독소휴극저안수궤수자표법분위대조조(n=6)、CVVH조(n=6,전희석법,등우후희석법적45 ml·kg-1·h-1)화고용량혈액려과(HVHF)조(n=6,전희석법,등우후희석법적70 m1·kg-1·h-1).우조모전(기선)、성모시(TO),성모후1 h(T1)、6 h(T6)、12 h(T12)、24 h(T24)분별측정혈장종류배사인자α(TNF-α)、백세포개소(IL)6、IL-10화IL-18수평.결과 대조조동물평균생존시간위(15.4±5.2)h;CVVH조위(21.4±7.1)h;HVHF조위(22.4±6.7)h,CVVH조화HVHF조적생존시간현저고우대조조(균P<0.05).3조동물적심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)화심배출량(CO)지간차이무통계학의의(P>0.05).내독소휴극저성모후출현BUN화Scr적진행성승고,량치료조적BUN화Scr수평현저저우대조조(P<0.05),단량자지간차이무통계학의의(P>0.05).대조조TNF-α화IL-6수평재T1시체고봉,IL-10수평재TO시최고,수후불단하강.IL-18수평재성모후상승,후무명현변화.CVVH조혈장IL-10(T6、T12、T24)수평저우대조조(P<0.05).HVHF조TNF-α(T6)화IL-10(T6、T12、T24)수평저우대조조화CVVH조(P<0.05),3조적IL-6화IL-18수평차이무통계학의의,IL-6(T6、T12)수평화동물생존시간정부상관(P<0.05).결론 CVVH화HVHF치료균능현저연장내독소휴극저적생존시간.CVVH능유효청제IL-10;HVHF치료능청제TNF-α화IL-10;단CVVH화HVHF대IL-6화IL-18수평무명현영향;CVVH화HVHF균능유효청제BUN화Scr.IL-6수평시예측내독소휴극예후적독립지표.
Objective To study the impact and mechanism of continuous venovenous hemofiltration (CVVH) in different uhrafihration rates on plasma cytokines in porcine endotoxemic shock. Methods Eighteen anesthetized mechanically ventilated pigs weighing 21-34 kg were randomly divided into three groups. In control group (n=6), the pigs received a 15.7 μg/kg endotoxin (E.coli 0111:84) infusion. In CVVH group (n=6) and high volume hemofihration (HVHF) group (n=6), the pigs received CVVH after the endotoxin infusion for 24 hours with an was taken before endotoxin infusion and at 0, 1, 6, 12, 24 h during CVVH. The plasma levels of TNF-α, IL-6, IL-10 and IL-18 were tested by ELISA. Results The survival time in control group was (15.4±5.2) h,CVVH group was (21.4±7.1) h,HVHF group was (22.4±6.7) h. The survival time in CVVH and HVHF group was significantly longer than that of control group (P< 0.05 ). Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP) and cardiac output (CO) showed no significant differences among three groups. Plasma BUN and Ser increased gradually after the establishment of porcine endotoxemic shock model. BUN and Scr of CVVH and HVHF group were lower compared to control group (P<0.05), but there was no significant difference between CVVH and HVHF group (P>0.05). Plasma TNF-α and IL-6 peaked at T1, IL-10 peaked at TO, then they declined gradually. While IL-18 increased at TO and did not change after TO. A significant decrease of plasma IL-10 level was observed at T6, T12 and T24 in CVVH group compared with control group (P<0.05). HVHF group accomplished a greater decrease in plasma TNF-α (T6) and IL-10 (T6, T12, T24) levels compared with control group and CVVH group (P< 0.05). The levels of IL-6 and IL-18 showed no significant differences among three groups. There was a negative correlation between IL-6 and survival time (P<0.05). Conclusions HVHF and CVVH can prolong the survival time of porcine endotoxemic shock. IL-10 can be removed effectively with CVVH and HVHF. HVHF can also remove TNF-α effectively. CVVH and HVHF treatment can both remove BUN and Scr effectively. IL-6 is a powerful independent predictive factor for survival time of porcine endotoxemic shock.
