中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
9期
750-753
,共4页
血液滤过%血液吸附%人白细胞DR抗原低表达%脓毒症%免疫
血液濾過%血液吸附%人白細胞DR抗原低錶達%膿毒癥%免疫
혈액려과%혈액흡부%인백세포DR항원저표체%농독증%면역
Hemofiltration%Hemoabsorption%Low human leukocyte antigen DR expression%Sepsis%Immune
目的：探讨血液滤过联合血液吸附治疗对伴人白细胞DR抗原（HLA-DR）低表达脓毒症患者的免疫改善作用。方法采用前瞻性随机对照研究方法，纳入2012年3月至2015年3月绍兴市人民医院重症医学科年龄＞18岁、单核细胞HLA-DR＜30%的脓毒症患者。将入选的60例患者按随机数字表法分为试验组和对照组，每组30例。两组均采取脓毒症标准操作程序（SOP）进行治疗；试验组在此基础上，于1～3 d增加血液滤过联合血液吸附治疗，采用连续性静脉-静脉血液滤过（CVVH）模式，前稀释量4 L/h，血液滤过器HF2000串联血液吸附器HA-330H。分别于治疗前及治疗3、5、7 d检测患者外周血单核细胞HLA-DR表达水平；评价两组患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、机械通气时间、重症加强治疗病房（ICU）住院时间、28 d存活率。结果试验组和对照组患者治疗前HLA-DR表达均＜30%，且差异无统计学意义〔（25.9±7.3）%比（26.4±6.7）%，P＞0.05〕，试验组治疗3、5、7 d HLA-DR表达逐渐升高，且显著高于对照组〔3 d为（38.9±8.6）%比（29.3±7.1）%，5 d为（42.7±9.2）%比（31.4±6.5）%，7 d为（40.9±8.5）%比（29.4±6.7）%，均P＜0.05〕。试验组和对照组患者治疗前APACHEⅡ评分差异无统计学意义（分：22.4±5.3比21.7±6.2，P＞0.05）；试验组治疗3、5、7 d APACHEⅡ评分逐渐下降，且显著低于对照组（分：3 d为18.6±3.6比20.5±4.3，5 d为15.8±3.9比21.1±4.4，7 d为14.9±4.2比19.8±3.7，均P＜0.05）。与对照组比较，试验组机械通气时间（d：13.3±3.4比19.8±3.7，t＝6.432，P＝0.003）、 ICU住院时间（d：20.7±3.9比26.8±4.7，t＝5.452，P＝0.006）均明显缩短，28 d存活率明显升高（83.3%比73.3%，χ2＝3.121，P＝0.016）。结论血液滤过联合血液吸附可提高HLA-DR低表达脓毒症患者HLA-DR表达水平，一定程度上改善脓毒症患者免疫功能，并可改善患者病情及预后。
目的：探討血液濾過聯閤血液吸附治療對伴人白細胞DR抗原（HLA-DR）低錶達膿毒癥患者的免疫改善作用。方法採用前瞻性隨機對照研究方法，納入2012年3月至2015年3月紹興市人民醫院重癥醫學科年齡＞18歲、單覈細胞HLA-DR＜30%的膿毒癥患者。將入選的60例患者按隨機數字錶法分為試驗組和對照組，每組30例。兩組均採取膿毒癥標準操作程序（SOP）進行治療；試驗組在此基礎上，于1～3 d增加血液濾過聯閤血液吸附治療，採用連續性靜脈-靜脈血液濾過（CVVH）模式，前稀釋量4 L/h，血液濾過器HF2000串聯血液吸附器HA-330H。分彆于治療前及治療3、5、7 d檢測患者外週血單覈細胞HLA-DR錶達水平；評價兩組患者急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分、機械通氣時間、重癥加彊治療病房（ICU）住院時間、28 d存活率。結果試驗組和對照組患者治療前HLA-DR錶達均＜30%，且差異無統計學意義〔（25.9±7.3）%比（26.4±6.7）%，P＞0.05〕，試驗組治療3、5、7 d HLA-DR錶達逐漸升高，且顯著高于對照組〔3 d為（38.9±8.6）%比（29.3±7.1）%，5 d為（42.7±9.2）%比（31.4±6.5）%，7 d為（40.9±8.5）%比（29.4±6.7）%，均P＜0.05〕。試驗組和對照組患者治療前APACHEⅡ評分差異無統計學意義（分：22.4±5.3比21.7±6.2，P＞0.05）；試驗組治療3、5、7 d APACHEⅡ評分逐漸下降，且顯著低于對照組（分：3 d為18.6±3.6比20.5±4.3，5 d為15.8±3.9比21.1±4.4，7 d為14.9±4.2比19.8±3.7，均P＜0.05）。與對照組比較，試驗組機械通氣時間（d：13.3±3.4比19.8±3.7，t＝6.432，P＝0.003）、 ICU住院時間（d：20.7±3.9比26.8±4.7，t＝5.452，P＝0.006）均明顯縮短，28 d存活率明顯升高（83.3%比73.3%，χ2＝3.121，P＝0.016）。結論血液濾過聯閤血液吸附可提高HLA-DR低錶達膿毒癥患者HLA-DR錶達水平，一定程度上改善膿毒癥患者免疫功能，併可改善患者病情及預後。
목적：탐토혈액려과연합혈액흡부치료대반인백세포DR항원（HLA-DR）저표체농독증환자적면역개선작용。방법채용전첨성수궤대조연구방법，납입2012년3월지2015년3월소흥시인민의원중증의학과년령＞18세、단핵세포HLA-DR＜30%적농독증환자。장입선적60례환자안수궤수자표법분위시험조화대조조，매조30례。량조균채취농독증표준조작정서（SOP）진행치료；시험조재차기출상，우1～3 d증가혈액려과연합혈액흡부치료，채용련속성정맥-정맥혈액려과（CVVH）모식，전희석량4 L/h，혈액려과기HF2000천련혈액흡부기HA-330H。분별우치료전급치료3、5、7 d검측환자외주혈단핵세포HLA-DR표체수평；평개량조환자급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、궤계통기시간、중증가강치료병방（ICU）주원시간、28 d존활솔。결과시험조화대조조환자치료전HLA-DR표체균＜30%，차차이무통계학의의〔（25.9±7.3）%비（26.4±6.7）%，P＞0.05〕，시험조치료3、5、7 d HLA-DR표체축점승고，차현저고우대조조〔3 d위（38.9±8.6）%비（29.3±7.1）%，5 d위（42.7±9.2）%비（31.4±6.5）%，7 d위（40.9±8.5）%비（29.4±6.7）%，균P＜0.05〕。시험조화대조조환자치료전APACHEⅡ평분차이무통계학의의（분：22.4±5.3비21.7±6.2，P＞0.05）；시험조치료3、5、7 d APACHEⅡ평분축점하강，차현저저우대조조（분：3 d위18.6±3.6비20.5±4.3，5 d위15.8±3.9비21.1±4.4，7 d위14.9±4.2비19.8±3.7，균P＜0.05）。여대조조비교，시험조궤계통기시간（d：13.3±3.4비19.8±3.7，t＝6.432，P＝0.003）、 ICU주원시간（d：20.7±3.9비26.8±4.7，t＝5.452，P＝0.006）균명현축단，28 d존활솔명현승고（83.3%비73.3%，χ2＝3.121，P＝0.016）。결론혈액려과연합혈액흡부가제고HLA-DR저표체농독증환자HLA-DR표체수평，일정정도상개선농독증환자면역공능，병가개선환자병정급예후。
ObjectiveTo investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous veno-venous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.Results The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9±7.3)% vs. (26.4±6.7)%,P>0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9±8.6)% vs. (29.3±7.1)%, 5 days: (42.7±9.2)%vs. (31.4±6.5)%, 7 days: (40.9±8.5)% vs. (29.4±6.7)%, allP< 0.05]. There was no significant difference in APACHEⅡ score before treatment between experimental group and control group (22.4±5.3 vs. 21.7±6.2,P>0.05). APACHEⅡ score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6±3.6 vs. 20.5±4.3, 5 days: 15.8±3.9 vs. 21.1±4.4, 7 days: 14.9±4.2 vs. 19.8±3.7, allP< 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3±3.4 vs. 19.8±3.7,t = 6.432,P = 0.003) and length of ICU stay (days: 20.7±3.9 vs. 26.8±4.7,t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%,χ2 = 3.121,P = 0.016).Conclusion Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.
