摘要
目的 探讨高容量血液滤过 (HVHF)和连续性静静脉血液滤过 (CVVH)对多器官功能障碍综合征 (MODS)患者肿瘤坏死因子 α(TNFα)及可溶性 TNF受体 (s TNF R1和 s TNF R2 )水平的影响。方法 将 12例确诊为合并急性肾衰竭 (ARF)的 MODS患者随机分为两组 ,分别应用 CVVH和 HVHF方式治疗 ;用酶联免疫吸附法 (EL ISA)测定 CVVH和 HVHF治疗过程中血清 TNFα、s TNF R1和 s TNF R2水平。结果 HVHF和 CVVH治疗 8h后 ,患者血浆中肌酐 (SCr)和尿素氮 (BU N)均降低 (P均 <0 .0 5 )。在 HVHF治疗期间 ,血清 TNFα水平逐渐降低 ,以治疗后 8h下降最明显 ,与治疗前、治疗后 1h和 4 h血清TNFα水平比较均有显著性差异 (P均 <0 .0 0 1)。在 CVVH治疗期间血清 TNFα水平以及 CVVH和HVHF治疗过程中血清 s TNF R1、s TNF R2水平均无明显的变化 (P均 >0 .0 5 )。结论 HVHF治疗能明显增加 MODS患者的血清 TNFα清除能力 ,其对 s TNF R1和 s TNF R2等抗炎介质的影响较小。在MODS患者连续性肾脏替代 (CRRT)治疗方式选择上 ,更宜选用 HVHF治疗。
Objective To investigate whether serum tumor necrosis factor-α(TNF-α) and its receptors can be removed by high-volume hemofiltration( HVHF) or continuous veno-venous hemofiltration(CVVH). Methods The study was performed in 12 multiple organ dysfunstion syndrome(MODS) patients with acute renal failure(ARF). They were randomized to receive either CVVH (n =10) or HVHF(n=8). TNF-α and soluble tumor necrosis factor-receptor(sTNF-R1 and sTNF-R2) concentrations were measured in serum by enzyme-linked immunoadsorbent assay(ELISA). Results Compared with that before the therapy, the average concentrations of plasma crea tinine and urea were decreased significantly 8 hours after HVHF or CVVH in M ODS patients with ARF (P<0.001). In patients on HVHF, the serum TNF-α concentrations were significantly lower 8 hours after treatment (P<0.01) compared with that before treatment, 1 hour and 4 hours after treatment. There were not significant changes in the serum TNF-α concentrations in patients on CVVH and the serum sTNF-R1 a nd sTNF-R2 concentrations in patients on CVVH or HVHF. Conclusion In MODS patients with ARF undergoing HVHF, the serum TNF-α concent rations dropped significantly, but the serum sTNF-R1 and sTNF-R2 concentrations do not change significantly. Our study suggest t hat HVHF may be the better option for the treatment of MODS patients.
出处
《中国危重病急救医学》
CAS
CSCD
2004年第2期81-84,共4页
Chinese Critical Care Medicine
基金
国家科技部生命科学技术发展中心科研基金资助课题 (9692 0 3 70 8)
