连续性血浆滤过吸附对重症急性胰腺炎细胞因子的调节作用

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摘要目的探讨连续性血浆滤过吸附（CPFA）治疗重症急性胰腺炎的效果及其对肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）的影响。方法选择2014年10月~2018年6月大连市中心医院重症医学科收治的40例重症急性胰腺炎患者，根据治疗方法将其分为对照组（n = 20）和治疗组（n = 20）。对照组在常规治疗基础上行连续性静脉静脉血液滤过（CVVH）治疗72 h，治疗组在对照组基础上加用CPFA治疗。治疗前及治疗3、7 d后，测量血液中的TNF-α、IL-6、IL-10水平；比较治疗前后两组患者的生命体征、腹腔内压力、急性生理与慢性健康（APACHEⅡ）评分等，评估脏器功能，观察不良反应及预后。结果两组患者治疗前各临床指标比较，差异无统计学意义（P > 0.05）。治疗3 d后，两组心率、氧合指数、腹腔内压力及APACHEⅡ评分均较治疗前降低，平均动脉压、白细胞计数较治疗前升高，差异有统计学意义（P ＜ 0.05）；治疗组心率、腹腔内压力低于对照组，平均动脉压高于对照组，差异有统计学意义（P ＜ 0.05）。治疗7 d后，两组心率、白细胞计数、腹腔内压力及APACHEⅡ评分均较治疗前降低，平均动脉压、氧合指数较治疗前升高，差异有统计学意义（P ＜ 0.05）；治疗组心率、腹腔内压力及APACHEⅡ评分低于对照组，平均动脉压高于对照组，差异有统计学意义（P ＜ 0.05）。治疗前两组的TNF-α、IL-6、IL-10水平差异无统计学意义（P > 0.05）。血液净化治疗3 d，两组的促炎性细胞因子TNF-α、IL-6均较治疗前下降，且治疗组的TNF-α及IL-6水平低于对照组，差异有统计学意义（P ＜ 0.05）；两组的抗炎性细胞因子IL-10均升高，治疗组IL-10水平高于对照组，差异有统计学意义（P ＜ 0.05）。治疗7 d后，两组的促炎性细胞因子水平进一步下降，且治疗组低于对照组，差异有统计学意义（P ＜ 0.05）；而抗炎性细胞因子水平进一步升高，且治疗组高于对照组，差异有统计学意义（P ＜ 0.05）。治疗组的平均住院天数及需要继续血液净化治疗的时间明显短于对照组，差异有统计学意义（P ＜ 0.05），但两组的病死率差异无统计学意义（P ＞ 0.05）。结论 CPFA可以更好地调节血液中的细胞因子水平，从而改善临床症状，缩短治疗时间，治疗重症急性胰腺炎。

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	周恒杰刘思伯舒姣洁

关键词 ：重症急性胰腺炎, 连续性血浆滤过吸附, 连续性血液滤过, 细胞因子

Abstract：Objective To investigate the effect of continuous plasma filtration adsorption (CPFA) on severe acute pancreatitis and its effects on tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10). Methods A total of 40 patients with severe acute pancreatitis were selected from October 2014 to June 2018 in the Department of Severe Medicine of Dalian Central Hospital. They were divided into control group (n = 20) and treatment group (n = 20) according to the treatment method. The control group was treated with continuous venovenous hemofiltration (CVVH) for 72 hours on the basis of routine treatment, while the treatment group was treated with CPFA on the basis of the control group. The levels of TNF-α, IL-6 and IL-10 in blood were measured before and after treatment for 3 and 7 days. The vital signs, intra-abdominal pressure, acute physiology and chronic health (APACHEⅡ) scores were compared between the two groups before and after treatment, and the organ function was evaluated, adverse reactions and prognosis were observed. Results There was no significant difference in the clinical indexes between the two groups before treatment (P > 0.05). After 3 days of treatment, the heart rate, oxygenation index, intra-abdominal pressure and APACHE Ⅱ scores of the two groups were lower than those before treatment, and the average arterial pressure and white blood cell count were higher than those before treatment (P < 0.05); the heart rate and intra-abdominal pressure of the treatment group were lower than those of the control group, and the average arterial pressure was higher than that of the control group (P < 0.05). After 7 days of treatment, the heart rate, white blood cell count, intra-abdominal pressure and APACHE Ⅱ scores of the two groups were lower than those before treatment, and the average arterial pressure and oxygenation index were higher than those before treatment (P < 0.05); the heart rate, intra-abdominal pressure and APACHE Ⅱ scores of the treatment group were lower than those of the control group, and the average arterial pressure was higher than that of the control group, with significant differences (P < 0.05). There was no significant difference in the levels of TNF-α, IL-6 and IL-10 between the two groups before treatment (P > 0.05). After 3 days of treatment, the levels of pro-inflammatory cytokines TNF-α, IL-6 in the two groups decreased, the levels of TNF-α and IL-6 in the treatment group were lower than those in the control group (P < 0.05), and the levels of anti-inflammatory cytokines IL-10 in both groups were increased (P < 0.05), and the level of IL-10 in the treatment group was higher than that in the control group (P < 0.05). After 7 days of treatment, the levels of pro-inflammatory cytokines in the two groups decreased further, and the treatment group was lower than the control group, the difference was statistically significant (P < 0.05); while the anti-inflammatory cytokine levels were further increased, and the treatment group was higher than the control group, the difference was statistically significant (P < 0.05). The average hospitalization days and the time needed to continue blood purification treatment in the treatment group were significantly shorter than those in the control group (P < 0.05), but there was no significant difference in mortality between the two groups (P > 0.05). Conclusion CPFA can better regulate the levels of cytokines in the blood, thereby improving clinical symptoms, shortening treatment time and treating severe acute pancreatitis.

Key words： Severe acute pancreatitis Continuous plasma filtration adsorption Continuous veno-venous hemofiltration Cytokine

基金资助:辽宁省科技计划项目（2014-0076W）。

作者简介: 周恒杰（1980.10-），男，硕士，副主任医师；研究方向：重症医学。

引用本文:

周恒杰刘思伯舒姣洁. 连续性血浆滤过吸附对重症急性胰腺炎细胞因子的调节作用[J]. 中国医药导报, 2019, 16(4): 92-95,99.
ZHOU Hengjie LIU Sibo SHU Jiaojie. Effect of continuous plasma filtration adsorption in the treatment of severe acute pancreatitis. 中国医药导报, 2019, 16(4): 92-95,99.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I4/92

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