Toft P, Kehler D, Brandslund I, Tønnsen E
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Crit Care. 1999;3(6):159-165. doi: 10.1186/cc370.
Haemodynamic instability is common in septic patients with acute renal failure. Continuous veno-venous haemodiafiltration (CVVHD) is therefore used as an alternative to conventional haemodialysis. Haemodialysis is associated with an activation of the immune system. The aim of the present study was to test the hypothesis that initiation of CVVHD influences the immune system with release of proinflammatory cytokines followed by a decrease in granulocyte activation, as assessed by the expression of adhesion molecules. RESULTS: Fifteen patients were included. Mean Acute Physiology and Chronic Health Evaluation-2 score before CVVHD was 19 (range 8-27). Mean duration of CVVHD treatment was 9 days (1-21 days). Tumour necrosis factor-alpha and interleukin-8 were detectable in plasma in all patients, whereas interleukin-10 was detectable only in a few patients. Proinflammatory and anti-inflammatory cytokines were detected in the ultrafiltrate. Large intraindividual and interindividual variations were demonstrated for all of the immunological parameters studied. CONCLUSION: The hypothesis that CVVHD induces the release of proinflammatory cytokines followed by a decrease in granulocyte activation was not confirmed in the present study. The heterogeneous group of patients studied, with different underlying diseases and various durations of illness before the start of CVVHD, might have contributed to the difficulty in demonstrating the proposed immunological effect of CVVHD.
血流动力学不稳定在合并急性肾衰竭的脓毒症患者中很常见。因此，连续性静脉-静脉血液透析滤过（CVVHD）被用作传统血液透析的替代方法。血液透析与免疫系统的激活有关。本研究的目的是检验这一假设：CVVHD的启动会影响免疫系统，导致促炎细胞因子释放，随后粒细胞激活减少，这通过黏附分子的表达来评估。结果：纳入了15名患者。CVVHD前急性生理与慢性健康状况评分系统Ⅱ（APACHE-Ⅱ）的平均分值为19分（范围8 - 27分）。CVVHD治疗的平均持续时间为9天（1 - 21天）。所有患者血浆中均可检测到肿瘤坏死因子-α和白细胞介素-8，而只有少数患者可检测到白细胞介素-10。超滤液中检测到促炎和抗炎细胞因子。所研究的所有免疫学参数均显示出较大的个体内和个体间差异。结论：本研究未证实CVVHD诱导促炎细胞因子释放，随后粒细胞激活减少这一假设。所研究的患者群体异质性较大，存在不同的基础疾病以及CVVHD开始前不同的病程，这可能导致难以证明CVVHD所提出的免疫学效应。
