2018 年第 2 期 第 13 卷

连续性血液净化治疗对急性呼吸窘迫综合征患者肿瘤坏死因子α和白细胞介素1水平及预后的影响

作者：陈玮

英文作者：

单位：730050兰州市第一人民医院重症医学科

英文单位：

关键词：急性呼吸窘迫综合征；连续性血液净化；肿瘤坏死因子α；白细胞介素1

英文关键词：

• 摘要：

• 目的    探讨连续性血液净化(CBP)治疗对急性呼吸窘迫综合征（ARDS）患者肿瘤坏死因子α（TNF-α）、白细胞介素1（IL-1）水平及预后的影响。方法    选取2014年2月至2016年2月兰州市第一人民医院收治的ARDS的患者32例。16例行CBP治疗，为血液净化组；16例未予CBP治疗，为对照组。CBP组采用连续性静脉-静脉血液透析滤过模式治疗3～5 d，对照组采用常规治疗。监测2组患者治疗12、24、36、48、72 h后外周血清TNF-α、IL-1水平，治疗2、6、12、24、36、48、72 h后血氧分压、二氧化碳分压、氧合指数及2组患者的病死率。结果    治疗36、48、72 h后血液净化组TNF-α、IL-1水平明显低于对照组，差异均有统计学意义［TNF-α：（36.42±0.41）ng/L比（49.54±0.47）ng/L、（32.79±0.32）ng/L比（51.36±0.24）ng/L、（29.47±0.58）ng/L比（56.68±0.21）ng/L；IL-1：（28±6）ng/L比（48±15）ng/L、（25±4）ng/L比（54±10）ng/L、（23±3）ng/L比（80±14）ng/L］(均P＜0.05)。治疗24、36、48、72 h后血液净化组血氧分压、氧合指数明显高于对照组，二氧化碳分压明显低于对照组，差异均有统计学意义(均P＜0.05)。血液净化组病死率低于对照组，差异有统计学意义［18.8%（3/16）比43.8%（7/16）］（P＜0.05）。结论    CBP治疗能明显抑制ARDS患者TNF-α和IL-1的表达，改善患者氧合状态，降低患者病死率。

• Effect of continuous blood purification on tumor necrosis factor-α, interleukin-1 and prognosis in patients with acute respiratory distress syndrome

  Chen Wei

  Intensive Care Unit, the First People′s Hospital of Lanzhou City, Lanzhou 730050, China, Email: 974254151@qq.com

  【Abstract】Objective    To investigate the effect of continuous blood purification(CBP) on tumor necrosis factor(TNF)-α, interleukin(IL)-1 and prognosis in patients with acute respiratory distress syndrome(ARDS). Methods    Thirty-two ARDS patients were enrolled from February 2014 to February 2016 in the First People′s Hospital of Lanzhou City; 16 of them had CBP therapy for 3-5 d（CBP group） and 16 patients had routine treatments（control group）. Serum levels of TNF-α and  IL-1 were detected 12, 24, 36, 48, 72 h after treatment. Partial pressure of oxygen, partial pressure of carbon dioxide and oxygenation index were measured 2, 6, 12, 24, 36, 48, 72 h after treatment. The fatality rate was analyzed. Results    Levels of TNF-α and IL-1 36, 48, 72 h after treatment in CBP group were significantly lower than those in control group［TNF-α: （36.42±0.41）ng/L vs （49.54±0.47）ng/L, （32.79±0.32）ng/L vs（51.36±0.24）ng/L, （29.47±0.58）ng/L vs （56.68±0.21）ng/L; IL-1: （28±6）ng/L vs （48±15）ng/L,（25±4）ng/L vs （54±10）ng/L, （23±3）ng/L vs （80±14）ng/L］(P＜0.05). Partial pressure of oxygen and oxygenation index 24, 36, 48, 72 h after treatment in CBP group were significantly higher, and partial pressure of carbon dioxide was significantly lower than those in control group(P<0.05). The fatality rate in CBP group was significantly lower than that in control group［18.8%（3/16） vs 43.8%（7/16）］（P＜0.05）. Conclusion    CBP can significantly inhibit expressions of TNF-α and IL-1, improve oxygenation status and reduce the fatality in patients with ARDS.

  【Key words】Acute respiratory distress syndrome;Continuous blood purification;Tumor necrosis factor-α;Interleukin-1