持续低效血液透析滤过对重症急性胰腺炎患者肠黏膜屏障功能及免疫功能的影响

doi:10.3969/j.issn.1001-9057.2019.11.009

摘要/Abstract

摘要： 目的评价持续低效血液透析滤过（SLEDF）对重症急性胰腺炎（SAP）患者肠黏膜屏障功能及免疫功能的影响。方法将51例SAP患者随机分为持续静脉静脉血液滤过（CVVH）组25例和SLEDF组26例，在常规治疗基础上分别接受CVVH和SLEDF治疗。比较两组患者预后、血、尿淀粉酶恢复正常时间、治疗前和治疗第2、4、8、14d血D-乳酸、内毒素（ET）、二胺氧化酶(DAO)、CD3⁺、CD4⁺、CD8⁺T淋巴细胞水平、CD4⁺/CD8⁺T淋巴细胞比值及血液净化相关并发症发生情况。结果两组患者死亡率、血、尿淀粉酶恢复正常时间比较差异均无统计学意义，血D-乳酸、ET、DAO、CD3⁺、CD4⁺、CD8⁺T淋巴细胞水平和CD4⁺/CD8⁺T淋巴细胞比值在治疗前和治疗第2、4、8、14d比较差异均无统计学意义（P>0.05）。两组患者治疗第4、8、14d D乳酸、ET和DAO水平均较同组治疗前降低，第8、14d均较同组治疗第4d降低（P＜0.05）。两组患者治疗第4、8、14d的CD3⁺、CD4⁺、CD8⁺T淋巴细胞水平和CD4⁺/CD8⁺T淋巴细胞比值均较同组治疗前升高，第8、14d均较同组治疗第4d升高（P＜0.05）；两组患者治疗第4、8d的CD8⁺T淋巴细胞水平较同组治疗前降低，第8、14d较第4d降低（P＜0.05）。结论 SLEDF和CVVH改善SAP患者肠道屏障功能障碍和免疫功能异常的作用相似，其中SLEDF操作方便，医疗费用低，值得临床推广。

关键词: 重症急性胰腺炎; 持续低效血液透析滤过; 肠黏膜屏障功能; 免疫功能

Abstract: Objective To evaluate the effect of sustained low-efficiency diafiltration(SLEDF) on intestinal mucosal barrier dysfunction and immune dysfunction in patients with severe acute pancreatitis（SAP）.Methods Fifty-one patients with SAP were randomly divided into continuous veno-venous hemofiltration(CVVH) group with 25 patients and SLEDF group with 26 patients,CVVH and SLEDF were treated separately on the basis of routine treatment.Prognosis,recovery time for blood and urine amylase,blood D-lactic acid,endotoxin(ET),diamine oxidase(DAO),CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio before and on the 2nd,4th,8th,14th day after treatment,complications related to blood purification were collected and compared in the two groups.Results There were no significant differences between the two groups in the mortality rate and the recovery time of blood and urine amylase,there were no significant differences in blood D-lactic acid,ET,DAO,CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺T lymphocyte ratio between the two groups before and on the 2nd,4th,8th,14th day after treatment（P>0.05）.The levels of D-lactic acid,ET and DAO in both groups were lower on the 2nd,4th,8th,14th day after treatment,the levels on the 8th and 14th day were lower than those on the 4th day（P＜0.05）.CD3⁺,CD4⁺T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio in the two groups on the 4th,8th,14th day were higher than those in the same group before treatment,the levels on the 8th and 14th day were higher than those on the 4th day（P＜0.05）.CD8⁺ T lymphocyte level in the two groups on the 4th,8th day were lower than those in the same group before treatment,the levels on the 8th and 14th day were lower than those on the 4th day（P＜0.05）.Conclusion SLEDF and CVVH could improve intestinal mucosal barrier dysfunction and immune dysfunction in SAP patients.SLEDF is worth popularizing in clinic because of convenient operation and low medical cost.

Key words: Severe acute pancreatitis; Sustained low-efficiency diafiltration; Intestinal mucosal barrier dysfunction; Immune dysfunction

邓妍妍, 金莎, 叶婷婷, 沈建明, 李骏峰, 肖寿海. 持续低效血液透析滤过对重症急性胰腺炎患者肠黏膜屏障功能及免疫功能的影响[J]. 临床内科杂志, 2019, 36(11): 744-747.

持续低效血液透析滤过对重症急性胰腺炎患者肠黏膜屏障功能及免疫功能的影响

Effects of sustained low-efficiency diafiltration on intestinal mucosal barrier dysfunction and immune dysfunction in patients with severe acute pancreatitis

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