伏晓琳;杨云;赵志林;段颖;谭辉;张怡;刘博;李康;杨琼;牛静;
FU Xiaolin;YANG Yun;ZHAO Zhilin;DUAN Ying;TAN Hui;ZHANG Yi;LIU Bo;LI Kang;YANG Qiong;NIU Jing;Central Hospital of Xianyang;

• 1:咸阳市中心医院

摘要(Abstract)：

目的:观察连续血液净化(CBP)治疗严重脓毒症疗效及对T淋巴细胞亚群影响。方法:86例严重脓毒症患者均分为观察组和对照组,观察组给予CBP治疗,对照组接受常规治疗,分别于治疗前和治疗第3及7天时采用Attune Nx T流式细胞仪测定T淋巴细胞亚群CD3~+T、CD4~+T、CD8~+T百分比及CD4~+T/CD8~+T比值,双抗体夹心酶联免疫分析法及免疫比浊法测定血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及C反应蛋白(CRP)水平;观察两组ICU住院时间、机械通气时间及28 d时死亡率。结果:2组患者治疗前T淋巴细胞亚群百分比比较差异无统计学意义(P>0.05),治疗第3及7天时CD3~+、CD4~+百分比及CD4~+/CD8~+比值均呈增高趋势,CD8~+百分比呈下降趋势,差异有统计学意义(P<0.05);观察组治疗第3及7天时CD3~+、CD4~+百分比及CD4~+/CD8~+比值均显著高于对照组,CD8~+百分比显著低于对照组(P<0.05);两组患者治疗前IL-6、TNF-α、CRP水平比较无统计学意义(P>0.05),治疗第3及7天时各炎症因子水平均呈下降趋势(P<0.05),且观察组治疗第3及7天时上述各炎症因子水平均显著低于对照组,差异有统计学意义(P<0.05);观察组ICU住院时间、机械通气时间及28 d死亡率显著低于对照组,差异有统计学意义(P<0.05)。结论:CBP治疗严重脓毒症疗效确切,能显著增强患者受抑制的免疫功能,降低致炎介质,改善预后。
Objective: To observe the effect of continuous blood purification( CBP) on severe sepsis and its influence on T lymphocyte subsets. Methods: 86 cases with severe sepsis were randomly divided into observation group and control group with equal number; the observation group received CBP treatment,the control group received routine treatment. Before treatment,and on the 3~(rd) and 7~(th) day after treatment adopting Attune Nx T Flow cytometry to test proportion of CD3~+T,CD4~+T and CD8~+T and ratio of CD4~+T/CD8~+T in T lymphocyte subsets. ABC-ELISA and Immunoturbidimetry were adopted to test levels of TNF-α,IL-6 and CRP. Observing ICU hospitalized time,mechanical ventilation time and mortality on 28~(th) day of both groups. Results: Comparison of proportion of T lymphocyte subsets of both groups before treatment showed no statistical difference( P > 0. 05); on the 3~(rd) and 7~(th) day after treatment,proportion of CD3~+,CD4~+ and ratio of CD4~+/CD8~+ showed an growing tendency,CD8~+percentage showed a decreasing trend,differences were statistically significant( P < 0. 05);on 3~(rd) and 7~(th) day after treatment,the percentage of CD3~+,CD4~+ and CD4~+/CD8~+ ratio were obviously higher than that of control group,were increased( P < 0. 05),the percentage of CD8~+was significantly lower than the control group( P < 0. 05). IL-6,TNF-alpha and CRP level of both groups before treatment was not statistically significant( P > 0. 05); 3 d and 7 d after treatment,the levels of inflammatory factors were decreased( P < 0. 05); and 3 d and 7 d after treatment,inflammatory cytokine levels of the observation group were significantly lower than that of control group( P < 0. 05).ICU hospitalized time,mechanical ventilation time and mortality on 28~(th) day of observation group were obviously lower than that of control group,differences were statistically significant( P < 0. 05).Conclusions: CBP is effective in the treatment of severe sepsis,which can significantly enhance the suppressed immune function,remove the inflammatory mediators and improve the prognosis.

关键词(KeyWords)： 连续血液净化;严重脓毒症;T淋巴细胞;炎症因子;免疫功能
continuous blood purification;severe sepsis;T lymphocytes;inflammatory factors;immune function

Abstract:

Keywords:

基金项目(Foundation): 陕西省自然科学基金项目(2012JM4011)

作者(Author): 伏晓琳;杨云;赵志林;段颖;谭辉;张怡;刘博;李康;杨琼;牛静;
FU Xiaolin;YANG Yun;ZHAO Zhilin;DUAN Ying;TAN Hui;ZHANG Yi;LIU Bo;LI Kang;YANG Qiong;NIU Jing;Central Hospital of Xianyang;

Email:

DOI: 10.19367/j.cnki.1000-2707.2018.04.019

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