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目的:研究连续性血液净化(CBP)治疗对热射病患者组织因子的影响。方法:以34例热射病导致的多器官功能不全综合征(MODS)患者作为研究对象,所有患者行持续静脉血液滤过(CVVH)48h;以健康成人为对照。在治疗前以及CBP治疗各时间点,以ELISA法测定患者血清组织因子(TF)、可溶性血栓调节蛋白(sTM)、可溶性E选择素(sE-selectin)的水平,以流式细胞术测定单核细胞膜表面TF活性。用Pearson积差相关系数,研究血清TF与单核细胞膜表面TF活性、血清sTM以及sE-selectin的相关性。结果:与正常对照组比较,热射病患者血清TF、sTM和sE-selectin水平以及单核细胞膜表面TF活性明显增高(P<0.01)。与治疗前比较,CBP治疗导致血清TF、sTM和sE-selectin水平、单核细胞膜表面TF活性明显下降(P<0.05)。血清TF与单核细胞膜表面TF活性、血清sTM以及sE-selectin有显著相关性(P<0.05)。结论:CBP可以通过抑制单核细胞和内皮细胞产生TF以及直接清除血清TF,达到降低血清中过度产生的TF作用。
Objective: To study the effect of continuous blood purification (CBP) therapy on tissue factor in patients with heat stroke. Methods: Thirty-four patients with MODS caused by thermal disease were enrolled in this study. All patients underwent continuous venous hemofiltration (CVVH) for 48 hours. The control group was as healthy as control. Serum levels of tissue factor (TF), soluble thrombomodulin (sTM) and soluble E-selectin (sE-selectin) in patients before treatment and at various time points of CBP treatment were measured by ELISA. Cell membrane surface TF activity. Correlation of serum TF with the activity of TF on the surface of mononuclear cell membrane, serum sTM and sE-selectin was studied by Pearson’s product difference correlation coefficient. Results: Compared with the normal control group, the levels of TF, sTM and sE-selectin in serum and the activity of TF on the surface of monocytes were significantly increased (P <0.01). Compared with those before treatment, CBP treatment resulted in the decrease of serum TF, sTM and sE-selectin levels, while the TF activity on the surface of mononuclear cell membrane decreased significantly (P <0.05). Serum TF was significantly correlated with TF activity on monocytic membrane surface, serum sTM and sE-selectin (P <0.05). CONCLUSION: CBP can reduce the overproduction of TF in serum by inhibiting the production of TF from monocytes and endothelial cells and directly removing serum TF.