中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
12期
1215-1219
,共5页
茅尧生%李智鑫%吕铁%周蕾
茅堯生%李智鑫%呂鐵%週蕾
모요생%리지흠%려철%주뢰
脓毒症%血液滤过%单核细胞%miRNA-146
膿毒癥%血液濾過%單覈細胞%miRNA-146
농독증%혈액려과%단핵세포%miRNA-146
Sepsis%Hemofiltration%Monocytes%miRNA-146
目的 探讨高通量连续性血液滤过(high volume hemofiltration,HVHF)技术治疗对脓毒症患者外周血单核细胞miRNA-146表达的影响及治疗脓毒症的可能机制. 方法 选择符合纳入标准的创伤脓毒症患者25例,分入HVHF组;另选25例同样符合纳入标准的与HVHF组配对的性别相同、年龄和急性生理和慢性健康评分(APACHE)-Ⅱ相近但因某些原因未能行HVHF治疗而其余治疗措施相同的创伤脓毒症患者作为对照组.两组患者治疗过程在0,6,12,24,48 h时,分离外周血单核细胞,检测其miRNA-146表达量的变化.将治疗24 h后的两组患者分离外周血单核细胞,于体外培养,以脂多糖(lipopolysaccharide,LPS)刺激4,8,12,24,48 h时,检测单核细胞中miRNA-146表达量的变化;同时用ELISA法检测单核细胞培养液中TNF-0、IL-6、IL-10水平. 结果 (1)随着治疗的进行,HVHF组miRNA-146表达量较脓毒症组下调更显著;(2) HVHF组在孵育前及孵育后4,8h时,miRNA-146表达明显低于同时相点的脓毒症组,其单核细胞接受LPS再刺激后对炎症反应能力也较脓毒症组强. 结论 HVHF治疗对创伤脓毒症患者免疫功能有一定的恢复作用,可明显改善患者的预后.而HVHF治疗可通过间接下调单核细胞miRNA-146的表达水平,减轻其对单核细胞炎症因子释放的抑制作用,增强其对外界再刺激的反应能力,可能为其治疗机制之一.
目的 探討高通量連續性血液濾過(high volume hemofiltration,HVHF)技術治療對膿毒癥患者外週血單覈細胞miRNA-146錶達的影響及治療膿毒癥的可能機製. 方法 選擇符閤納入標準的創傷膿毒癥患者25例,分入HVHF組;另選25例同樣符閤納入標準的與HVHF組配對的性彆相同、年齡和急性生理和慢性健康評分(APACHE)-Ⅱ相近但因某些原因未能行HVHF治療而其餘治療措施相同的創傷膿毒癥患者作為對照組.兩組患者治療過程在0,6,12,24,48 h時,分離外週血單覈細胞,檢測其miRNA-146錶達量的變化.將治療24 h後的兩組患者分離外週血單覈細胞,于體外培養,以脂多糖(lipopolysaccharide,LPS)刺激4,8,12,24,48 h時,檢測單覈細胞中miRNA-146錶達量的變化;同時用ELISA法檢測單覈細胞培養液中TNF-0、IL-6、IL-10水平. 結果 (1)隨著治療的進行,HVHF組miRNA-146錶達量較膿毒癥組下調更顯著;(2) HVHF組在孵育前及孵育後4,8h時,miRNA-146錶達明顯低于同時相點的膿毒癥組,其單覈細胞接受LPS再刺激後對炎癥反應能力也較膿毒癥組彊. 結論 HVHF治療對創傷膿毒癥患者免疫功能有一定的恢複作用,可明顯改善患者的預後.而HVHF治療可通過間接下調單覈細胞miRNA-146的錶達水平,減輕其對單覈細胞炎癥因子釋放的抑製作用,增彊其對外界再刺激的反應能力,可能為其治療機製之一.
목적 탐토고통량련속성혈액려과(high volume hemofiltration,HVHF)기술치료대농독증환자외주혈단핵세포miRNA-146표체적영향급치료농독증적가능궤제. 방법 선택부합납입표준적창상농독증환자25례,분입HVHF조;령선25례동양부합납입표준적여HVHF조배대적성별상동、년령화급성생리화만성건강평분(APACHE)-Ⅱ상근단인모사원인미능행HVHF치료이기여치료조시상동적창상농독증환자작위대조조.량조환자치료과정재0,6,12,24,48 h시,분리외주혈단핵세포,검측기miRNA-146표체량적변화.장치료24 h후적량조환자분리외주혈단핵세포,우체외배양,이지다당(lipopolysaccharide,LPS)자격4,8,12,24,48 h시,검측단핵세포중miRNA-146표체량적변화;동시용ELISA법검측단핵세포배양액중TNF-0、IL-6、IL-10수평. 결과 (1)수착치료적진행,HVHF조miRNA-146표체량교농독증조하조경현저;(2) HVHF조재부육전급부육후4,8h시,miRNA-146표체명현저우동시상점적농독증조,기단핵세포접수LPS재자격후대염증반응능력야교농독증조강. 결론 HVHF치료대창상농독증환자면역공능유일정적회복작용,가명현개선환자적예후.이HVHF치료가통과간접하조단핵세포miRNA-146적표체수평,감경기대단핵세포염증인자석방적억제작용,증강기대외계재자격적반응능력,가능위기치료궤제지일.
Objective To investigate the effect of high volume hemofiltration (HVHF) on expression of miRNA-146 in peripheral blood mononuclear cells in posttraumatic sepsis patients and its therapeutic mechanism.Methods Twenty-five cases of posttraumatic sepsis were included as HVHF group.Another 25 age-and gender-matched traumatic sepsis patients with similar APACHE-Ⅱ who received no HVHF treatment for some reasons were used as controls.Therapeutic measurements were the same of the two groups except for HVHF.At 0-,6-,12-,24-and 48-hour time points,the peripheral blood mononuclear cells were isolated from patients of both groups to detect level of miRNA-146.Peripheral blood mononuclear cells isolated at 24 hours were incubated with lipopolysaccharide (LPS) in vitro.At hours 4,8,12,24 and 48 after incubation,level of miRNA-146 in mononuclear cells was determined and levels of TNF-α,IL-6,and IL-10 in the substrate was detected by ELISA.Results (1) Level of miRNA-146 in HVHF group was decreased significantly over time as compared with that in sepsis group;(2) Before incubation and at 4-and 8-hour after incubation,miRNA-146 level was lowered significantly in HVHF group as compared with that in sepsis group.After LPS stimulation,mononuclear cell also presented a stronger inflammatory response in HVHF group than in sepsis group.Conclusions HVHF provides a definite effect on immune function recovery and a significant improvement in prognosis.Moreover,HVHF may attenuate the impact of miRNA-146 on mononuclear cell inflammatory factor release and enhance the cell ability to respond to external stimuli again via down-regulating miRNA-146,as may be one of the therapeutic mechanisms of HVHF for posttraumatic sepsis.
