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1、第25卷第4期西安交通大学学报(医学版)Vol.25No.42004年8月JournalofXi'anJiaotongUniversity(MedicalSciences)Aug.2004血液净化对肾综合征出血热炎症介质的清除作用蒋红利,薛武军,尹爱萍,冯学亮(西安交通大学第一医院血透中心,陕西西安710061)摘要:目的通过观察连续性肾替代治疗(CRRT)对肾病综合征出血热(HFRS)患者肿瘤坏死因子α(TNF-α)、白介素6(IL-6)及内皮素-1(ET-1)的清除作用,探讨炎症介质在HFRS中的作用。方法将诊断为HFRS的中型及以上类型患者40例随机分为两
2、组:CVVH组20例行CVVH,HD组20例行HD。用ELISA法检测TNF-α和IL-6浓度,放射免疫法测定ET-1浓度。结果①CVVH组及HD组少尿天数(3.0±2.1,6.0±3.4)、并发症发生率(25%,40%)及病死率(15%,25%)差异均有显著性(P<0.01)。②两组治疗前后血肌酐和尿素氮下降有显著性差异(P<0.01)。③CVVH组治疗后血中TNF-α、IL-6和ET-1均较治疗前明显降低,差异均有显著性意义(P均<0.01);HD组治疗前后血中TNF-α、IL-6和ET-1无显著性差异(P>0.05)。④CVVH组滤出液中可持续检测到IL-
3、6及ET-1,未检测到TNF-α。透出液中未检测到上述炎症介质。结论连续性血液净化治疗可清除炎症介质,改善HFRS的病理生理过程,改善肾功能和预后,减少并发症,降低病死率,是治疗HFRS的最佳方法。关键词:肾综合征出血热;连续性肾替代治疗;血液透析;炎症介质中图分类号:R692.5文献标识码:A文章编号:1671-8259(2004)04-0385-03TheeffectofbloodpurificationonremovingplasmainflammatorymediatorsinHFRSpatientsJiangHongli,XueWujun,YinAip
4、ing,FengXueliang(DepartmentofHemodialysisCenter,FirstHospitalofXi'anJiaotongUniversity,Xi'an710061,China)ABSTRACT:ObjectiveToobservetheremovaloftumornecrosisfactor-α(TNF-α),interleukin-6(IL-6)andendothelin-1(ET-1)incontinuousrenalreplacementtherapy(CRRT)onhemorrhagicfeverwithrenalsyn
5、drome(HFRS)patients,andinvestigatetheeffectofinflammatorymediatorsonHFRS.MethodsAtotalof40patientswithmoderateormoresevereHFRSweredividedintotwogroupsrandomly.Continuousvenous-venoushemofiltration(CVVH)wasappliedtothe20casesinCVVHgroup,andhemodialysis(HD)wasappliedtothe20casesinHDgro
6、up.ThelevelsofTNF-αandIL-6weremeasuredbyenzyme-linkedimmunosorbentassay(ELISA),andET-1levelwasmeasuredbyradioimmunoassays(RIA).ResuIts①IncomparingCVVHandHDgroups,thedaysofoliguria(3.0±2.1,6.0±3.4),incidenceofcomplications(25%,40%),andmortality(15%,25%)hadsignificantdifferences(P<0.01
7、).②ThedecreaseofplasmaBUNandCrhadsignificantdifferencesbeforeandaftertreatmentinbothCVVHandHDgroups(P<0.01).③InCVVHgroup,theplasmalevelsofTNF-α,IL-6andET-1decreasedmarkedlyaftertreatmentincomparisonwiththosebeforetreatment,withsignificantdifferences(P<0.05).Incontrast,thelevelsofTNF-
8、α,IL-6andET-
