炎性细胞因子监测在判断CBP治疗SAP时机选择中的应用
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Determination of the application of CBP therapy performed on SAP by monitoring inflammatory cytokines
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    摘要:

    目的:通过监测炎性细胞因子的变化,分析连续性血液净化(continuous blood purification,CBP)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的时机与疗效之间的关系-方法:SAP患者入院后即行CBP治疗,CBP治疗模式为连续性静脉-静脉血液滤过(continuity veno-venos hemofiltration,CVVHF),每天治疗12 h,连续3 d-根据CBP治疗距SAP发病时间,将33例SAP患者随机分为A-B-C共3组,分别在SAP发病0~24-24~48-48~72 h开始给予CBP治疗-在CBP治疗开始及结束检测肿瘤坏死因子α(TNF-α)-白介素(IL)-1-IL-6-IL-8-血淀粉酶(amylase,AMY)-C反应蛋白(C-reactive protein,CRP)-APACHEⅡ评分等指标变化-结果:3组SAP患者经过CBP治疗后,TNF-α-IL-1-IL-6-IL-8等炎性细胞因子水平与AMY-CRP-APACHEⅡ评分等病情评估指标水平均较治疗前明显降低-比较3组SAP患者的AMY-CRP-APACHEⅡ评分等病情评估指标的降低幅度上,C组(48~72 h CBP治疗组)较A-B组(0~24-24~48 h CBP治疗组)明显减少;而TNF-α-IL-1-IL-6-IL-8等炎性细胞因子的降低幅度上,C组较A-B组明显增加-结论:通过CBP治疗可有效降低SAP患者炎性细胞因子的浓度,并改善病情-48 h内开始CBP治疗对SAP患者病情的改善幅度要优于48 h以后-

    Abstract:

    Objective:The purpose of this study is to investigate the relationship between the intervention time and the effect of continuous blood purification(CBP)therapy performed on severe acute pancreatitis(SAP)patients by monitoring the changes of inflammatory cytokines. Methods:A total of 33 SAP patients were hospitalized and treated with CBP therapy. The patients were randomly assigned into three groups(A,B,C)according to the time of CBP therapy performed after the onset of SAP,which is,0~24 h,24~48 h and 48~72 h,respectively. The CBP treatment is continuity veno-venos hemofiltration (CVVHF)for 12 h daily for 3 consecutive days. Blood sample of the patients were collected pre and post CBP therapy. Presence of TNF-α,IL-1,IL-6,IL-8,blood amylase(AMY),C-reactive protein(CRP)and APACHE Ⅱ score were measured and calculated. Results:It showed that the indicators for condition evaluation(AMY,CRP,APACHE Ⅱ score)and the level of inflammatory cytokines (TNF-α,IL-1,IL-6,IL-8),were lower post CBP therapy than that pre CBP therapy in all three groups of SAP patients. The decrease in the indicators for condition evaluation such as AMY,CRP and APACHE Ⅱ score in group C (48~72 h)was statistically lower than those in group A and B (0~24,24~48 h). However,the decrease in the level of inflammatory cytokines such as TNF-α,IL-1,IL-6,and IL-8 was higher in group C(48~72 h)than those in group A and B. Conclusion:CBP therapy can effectively reduce the level of inflammatory cytokines in SAP patients,and also improve their overall condition. SAP patients who received CBP therapy within 48 h show a better improvement in their condition by effectively reducing the level of inflammatory cytokines.

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张海滨,王旭东,史海娜.炎性细胞因子监测在判断CBP治疗SAP时机选择中的应用[J].南京医科大学学报(自然科学版),2016,(2):205-209

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  • 收稿日期:2015-09-13
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  • 在线发布日期: 2016-02-29
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