连续性血液净化对脓毒症患者单核细胞人类白细胞抗原DR表达及预后.doc

连续性血液净化对脓毒症患者单核细胞人类白细胞抗原DR表达及预后的影响 付素珍 马骏 孙杰 董云 赵琪 关炳星 【摘要】 目的 探讨应用连续性血液净化（CBP）后，严重脓毒症患者外周血单核细胞人类白细胞抗原DR（HLA-DR）表达水平变化及预后情况。 方法 将102例严重脓毒血症患者分为CBP组（60例）和常规治疗组（42例），在相同的常规治疗基础上，CBP组加用CBP治疗，至少持续治疗120h。于治疗前后比较两组患者急性生理学与慢性健康状况评分系统（APACHE）II评分和序贯器官功能衰竭（SOFA）评分；并记录两组患者28d生存率和重症医学科病房（ICU）住院时间。应用流式细胞仪检测治疗前及治疗后24h、72h、120h各时间点血浆T淋巴细胞亚群CD3+、CD4+、CD4+/CD8+及单核细胞HLA-DR表达。 结果 两组患者治疗前APACHEII评分、SOFA评分、CD3+、CD4+、CD4+/CD8+及单核细胞HLA-DR水平的差异均无统计学意义（P0.05）。治疗后CBP组患者APACHEII评分、SOFA评分均下降（P0.05）。两组患者28d生存率差异无统计学意义（P0.05），但CBP组ICU住院时间短于常规治疗组（P0.05）。治疗120h后，CBP组患者外周血CD3+、CD4+、CD4+/CD8+及HLA-DR表达水平较治疗前明显升高（P0.05），与同期常规治疗组比较，差异均有统计学意义（P0.05）。 结论 CBP能通过清除炎症介质，上调外周血单核细胞人类白细胞抗原DR表达，达到恢复机体促炎/抗炎平衡，从而改善严重脓毒血症患者的总体病情。 【关键词】 连续性血液净化；脓毒症；HLA-DR；预后； Continuous biood purification on monocyte human leukocyte antigen-DR expression and Prognosis in patients with severe sepsis FU Suzhen，MA Jun，SUN Jie，DONG Yun，ZHAO Qi，GUAN Bing xing. Department of Intensive Care Unit，People’s Hospital of Xin Tai City，Hebei，054001 China 【Abstract】 Objective To continuous biood purification（CBP） on the expression of monocyte human leukocyte antigen-DR(HLA-DR) and prognosis in patients with severe sepsis. Methods Hundred-two patients with severe sepsis were divided into CBP group (60 cases) and control group (42 cases) randomly.The patients in the control group were treated with conventional therapy，and the patients in the CBP group received at least 120h of CBP treatment additionly. The acute physiology and chronic health evaluation (APACHE) II score，The sequential organ failure assessment (SOFA) score，the 28-day survival rate and intensive care unit (ICU) length of stay were recorded and compared monocytes HLA-DR expression immunophenotype of lymphocyte (CD3+、CD4+、CD4+/CD8+) expression in peripheral blood mononuclear cells (PBMC) were measured before and at 24,72,120h after the treatment. Results There were no significant differences in the APACHEII and SOFA score，the level of plasma HLA-DR