连续性血液净化对挤压综合征致急性肾衰后外周血细胞因子的影响
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摘要
目的研究连续性静脉-静脉血液滤过(CVVH)对挤压伤导致的急性肾衰(ARF)的外周血细胞因子的影响。方法6例汶川地震挤压伤后ARF患者,经颈内静脉插管留置单针双腔导管行CVVH治疗,12h/d。分别在治疗前1小时和治疗后2,4,8,12小时留取患者的静脉血,采用ELISA法检测IL-1β、IL-2、IL-4、IL-6、IL-10、IL-8、TNF-α。结果6例患者肾功能完全恢复。治疗2小时后血浆炎性血细胞因子IL-1β、IL-2、IL-6、IL-8、TNF-α的水平逐渐降低,治疗后8小时降低最为明显,但在12小时后,均有不同程度的回升。与治疗前1小时相比,血浆抗炎细胞因子IL-4、IL-10治疗8小时后逐渐增高,12小时达最高。结论CVVH能有效清除挤压综合征致ARF产生的多种细胞炎性因子,促进肾功能恢复。因透析器清除作用具有饱和性,应适时更换血滤器帮助清除。
Objective To investigate the influence of continuous veno-venous hemofiltration on plasma cytokine in patients with acute renal failure after crush injuries.Methods 8 patients with acute renal failure after crush injuries in Wenchuan earthquake were treated with continuous veno-veno hemofiltration for 12h/d,continuously.The vascular access was estabolished with two-lumen indwelling catheter in internal jugular vein.The cytokines including IL-1β,IL-2,IL-4,IL-6,IL-10,IL-8,TNF-α were detected 1h before and 2h,4h,8h,12h after treatment with ELISA.Results 8 patients survived and their renal function completely recovered.The plasma levels of inflammatory cytokines including IL-1β,IL-2,IL-6,IL-8,TNF-α decreased gradually 2h after treatmentand reached the lowest point at 8h after CVVH.However,the plasma levels of inflammatory cytokines rose gradually at 12h after treatment.The plasma levels of anti-inflammatory cytokines IL-4,IL-10 increased gradually at 8h after CVVH,and reached the highest point at 12h after CVVH.Conclusion These results indicate that CVVH is effective to clear TNF-alpha,IL-1 beta,IL-2,IL-6 and IL-8 and improve of survival rate of patients with crush injury with acute renal failure.
Objective To investigate the influence of continuous veno-venous hemofiltration on plasma cytokine in patients with acute renal failure after crush injuries.Methods 8 patients with acute renal failure after crush injuries in Wenchuan earthquake were treated with continuous veno-veno hemofiltration for 12h/d,continuously.The vascular access was estabolished with two-lumen indwelling catheter in internal jugular vein.The cytokines including IL-1β,IL-2,IL-4,IL-6,IL-10,IL-8,TNF-α were detected 1h before and 2h,4h,8h,12h after treatment with ELISA.Results 8 patients survived and their renal function completely recovered.The plasma levels of inflammatory cytokines including IL-1β,IL-2,IL-6,IL-8,TNF-α decreased gradually 2h after treatmentand reached the lowest point at 8h after CVVH.However,the plasma levels of inflammatory cytokines rose gradually at 12h after treatment.The plasma levels of anti-inflammatory cytokines IL-4,IL-10 increased gradually at 8h after CVVH,and reached the highest point at 12h after CVVH.Conclusion These results indicate that CVVH is effective to clear TNF-alpha,IL-1 beta,IL-2,IL-6 and IL-8 and improve of survival rate of patients with crush injury with acute renal failure.
引文
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[2]Gonzalez D.Crush syndrome[J].Crit Care Med,2005,33(1Suppl):S34-S41.
[3]Gunal AI,Celiker H,Dogukan A,et al.Early and vigorous flu-id resuscitation prevents acute renal failure in the crush victims ofcatastrophic earthquakes[J].J Am Soc Nephrol,2004,15(7):1862-1867.
[4]Tef-Zafarmand A,Fadem S.Disaster nephrology:medical per-spective[J].Adv Ren Replace Ther,2003,10(2):104-116.
[5]王立金.挤压伤与多器官功能不全综合征[J].中国煤炭工业医学杂志,2004,7(10):907-909.
[6]Horner C,Schuster S,Plachky J,et al.Hemofiltration and im-mune response in severe sepsis[J].J Surg Res,2007,142(1):59-65.
[7]Delanaye P,Lambermont B,Dogne JM,et al.Confirmation ofhigh cytokine clearance by hemofiltration with a cellulose triace-tate membrane with large pores:an in vivo study[J].Int J ArtifOrgans,2006,29(10):944-948.
[8]Heering P,Grabensee B,Brause M.Cytokine removal in septicpatients with continuous venovenous hemofiltration[J].KidneyBlood Press Res,2003,26(2):128-134.
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