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目的:探讨连续性血液净化治疗重症急性胰腺炎(SAP)时对血清细胞因子水平的影响及机理。方法:选择2007-06/2010-06本院收治的重症急性胰腺炎患者108例,按照是否接受连续性血液净化治疗分为常规治疗组50例和连续性血液净化治疗组58例,监测治疗前后病情及行动态急性生理和慢性健康(APACHEII)评分变化,并分别在治疗0、6、12、24、48、72h各时间点采用放射免疫法检测两组患者血清中TNF-α、IL-6、IL-10、IL-8水平的变化。结果:经72h治疗后,CBP治疗组患者在腹痛缓解时间、住院时间及并发症发生方面均明显优于常规治疗组,且CBP治疗组患者A-PACHEⅡ评分有显著改善,住院期间死亡病例明显低于常规治疗组,两组间比较有显著性差异(P<0.05),CBP治疗组患者血清TNF-α、IL-6、IL-10、IL-8水平均较治疗前明显降低(P<0.05),而常规治疗组患者在治疗72h内所有上述细胞因子水平均较治疗前无明显变化(P>0.05)。结论:CBP治疗能快速有效改善SAP患者病情,清除患者血清中过多的TNF-α、IL-6、IL-10、IL-8细胞因子,改善SAP患者临床转归,可成为治疗SAP的重要辅助措施。
Objective: To investigate the effect of continuous blood purification on serum cytokines and its mechanism in the treatment of severe acute pancreatitis (SAP). Methods: One hundred and eighty patients with severe acute pancreatitis admitted in our hospital from June 2007 to June 2010 were divided into routine treatment group (n = 50) and continuous blood purification group (n = 58) according to whether they received continuous blood purification treatment. (APACHEII) scores of patients with acute respiratory distress syndrome (ACH) and their changes of APACHEII scores were measured. Serum levels of TNF-α and IL-6 were measured by radioimmunoassay at 0, 6, 12, 24, 48 and 72h after treatment , IL-10, IL-8 levels. Results: After 72 hours of treatment, the CBP treatment group was significantly better than the conventional treatment group in the time of remission, length of stay and complications, and the A-PACHEⅡ score of CBP treatment group was significantly improved, and the death rate during hospitalization was significantly lower The levels of TNF-α, IL-6, IL-10 and IL-8 in the CBP group were significantly lower than those before treatment in the conventional treatment group (P <0.05) ), While those in the conventional treatment group had no significant changes in all the above cytokines within 72 hours after treatment (P> 0.05). CONCLUSION: CBP treatment can rapidly and effectively improve the condition of patients with SAP. Removing excess serum TNF-α, IL-6, IL-10 and IL-8 cytokines and improving the clinical outcome of SAP patients may be important for the treatment of SAP Assistive measures.