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目的研究配对血浆滤过吸附(coupled plasma filtration adsorption,CPFA)治疗重症感染并多器官功能障碍综合征(multiple organ dysfunction syndromes,MODS)患者对血清细胞因子的影响。方法选择重症感染并MODS的患者7例,采用前瞻性,随机,自身交叉对照研究。每例患者均在常规药物治疗基础上加用CPFA(A)和高容量血液滤过(B)(high volume hemofiltration,HVHF)各治疗10h,A,B治疗顺序随机,间隔一夜洗脱期(12h),即A+B或B+A方案,比较两种治疗方式对七种血清细胞因子:肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、白细胞介素-10(IL-10)、白细胞介素-1受体拮抗剂(IL-1Ra)、可溶性肿瘤坏死因子受体1和受体2(sTNFR1、sTNFR2)的影响。结果①CPFA能明显降低血清TNF-α,升高IL-1Ra及sTNFR2/TNF-α、IL-1Ra/IL-1β的比值。10h与0h相比,均有统计学意义(P<0.05)。HVHF中,血清IL-1β在5h时较0h有下降,至10h又恢复到0h水平;血清IL-1Ra、IL-1Ra/IL-1β比值在5h时上升,至10h又明显下降至0h的水平。CPFA、HVHF对血清细胞因子TNF-α、IL-1Ra、sTNFR2/TNF-α、IL-1Ra/IL-1β的影响有统计学意义(P<0.05);②CPFA0h,TNF-α、IL-1β、IL-6经过整个装置后的下降率分别为38.95%,41.76%,44.39%;5h时下降率分别降至23.55%,16.18%,7.53%。HVHF除在0hIL-1β经过血滤器的下降率为45.52%外,HVHF0h或5h以上细胞因子浓度在动、静脉端均无统计学意义(P>0.05)。结论CPFA在降低致炎性细胞因子水平,提高抗炎/致炎因子比值方面,优于HVHF。提示CPFA治疗MODS有更广阔前景。
Objective To investigate the effect of paired plasma filtration adsorption (CPFA) on serum cytokines in patients with severe infection and multiple organ dysfunction syndromes (MODS). Methods Seven patients with severe infection and MODS were selected and prospective, randomized and self-controlled cross-over study was conducted. Each patient was treated with CPFA (A) and high volume hemofiltration (HVHF) for 10 hours on the basis of conventional medical therapy. The treatment sequences of A and B were randomly divided into two groups: ), Ie A + B or B + A regimen, compared the effects of the two treatments on seven serum cytokines: tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin- IL-1β, IL-10, IL-1Ra, sTNFR1, sTNFR2 influences. Results ① CPFA could significantly decrease the serum level of TNF-α, increase the ratio of IL-1Ra and sTNFR2 / TNF-α, IL-1Ra / IL-1β. 10h compared with 0h, there was statistical significance (P <0.05). In HVHF, serum IL-1β decreased at 0h and returned to 0h at 10h. The ratio of serum IL-1Ra and IL-1Ra / IL-1β increased at 5h and decreased to 0h at 10h . The effects of CPFA and HVHF on serum cytokines TNF-α, IL-1Ra, sTNFR2 / TNF-α and IL-1Ra / IL-1β were statistically significant (P < The descending rates of IL-6 after the whole device were 38.95%, 41.76% and 44.39%, respectively. The descending rates of IL-6 decreased to 23.55%, 16.18% and 7.53% respectively at 5 hours. HVHF except for 0hIL-1β decreased by 45.52% through the blood filter, the HVHF0h or 5h cytokine concentration in the arterial and venous ends were not statistically significant (P> 0.05). Conclusions CPFA is superior to HVHF in reducing the levels of pro-inflammatory cytokines and increasing the ratio of anti-inflammatory / proinflammatory cytokines. Tip CPFA treatment of MODS has a broader perspective.