Rokyta R, Holub M, Matĕjovic M, Hanzlíková J, Helcl M, Novák I, Srámek V, Krouzecky A, Príhodová J
ICU, Department of Internal Medicine I, Charles University Hospital Plzen, Czech Republic.
Int J Artif Organs. 2002 Nov;25(11):1066-73. doi: 10.1177/039139880202501105.
The aim of this study was to test the hypothesis that continuous venovenous hemofiltration (CVVH) increases HLA-DR expression on monocytes and T lymphocytes in critically ill patients. 24 septic (SP) and 10 non-septic (NSP) medical ICU patients with acute renal failure were studied prospectively. The ultrafiltration rate was 20-30 ml.kg(-1).h(-1). The total and differential white cell counts were measured and CD3+ lymphocyte count, HLA-DR expression on CD14+ monocytes and CD3+ lymphocytes were analysed by two-colour flow cytometry before, 4 and 24 h after CVVH initiation, respectively. CVVH did not influence leukocyte, granulocyte, total lymphocyte and CD3+ lymphocyte counts in both groups of patients. The percentage of HLA-DR+/CD14+ monocytes in SP revealed no changes, whereas it decreased after 4 h of CWH in NSP (p < 0.05). The percentage of HLA-DR+/CD3+ lymphocytes in SP decreased after 24 h (p < 0.05), whereas it remained unchanged in NSP. We conclude that CWH initiation is not associated with the increase of HLA-DR expression on CD14+ monocytes and T lymphocytes in critically ill patients with acute renal failure.
连续性静脉-静脉血液滤过（CVVH）可增加危重症患者单核细胞和T淋巴细胞上HLA-DR的表达。对24例患有急性肾衰竭的脓毒症（SP）患者和10例非脓毒症（NSP）内科重症监护病房患者进行了前瞻性研究。超滤率为20 - 30 ml·kg⁻¹·h⁻¹。分别在CVVH开始前、开始后4小时和24小时测量白细胞总数及分类计数，并通过双色流式细胞术分析CD3⁺淋巴细胞计数、CD14⁺单核细胞和CD3⁺淋巴细胞上HLA-DR的表达。CVVH对两组患者的白细胞、粒细胞、总淋巴细胞和CD3⁺淋巴细胞计数均无影响。SP组中HLA-DR⁺/CD14⁺单核细胞的百分比无变化，而NSP组在CVVH 4小时后该百分比下降（p < 0.05）。SP组中HLA-DR⁺/CD3⁺淋巴细胞的百分比在24小时后下降（p < 0.05），而NSP组保持不变。我们得出结论，对于患有急性肾衰竭的危重症患者，开始CVVH与CD14⁺单核细胞和T淋巴细胞上HLA-DR表达的增加无关。
