Bellomo R, Tipping P, Boyce N
Department of Medicine, Monash Medical Centre, Melbourne, Australia.
ASAIO Trans. 1991 Jul-Sep;37(3):M322-3.
Tumor necrosis factor alpha (TNF) is a mediator of injury in the critically ill. Its small molecular size (17 kd) should allow its clearance during continuous hemodiafiltration (CHD). The authors studied TNF extraction in 12 critically ill patients (APACHE II score 26.3 mean; range, 19-34) receiving CHD. Tumor necrosis factor levels were measured in prefiltered and filtered blood and ultradiafiltrate at 0.4 and 24 hours of therapy. Before CHD, mean plasma TNF levels were 261 pg/ml (95% confidence interval [CI]: 184-578) and 291 pg/ml (95% CI: 0-589) after 24 hours. There were no statistically significant differences between prefilter and postfilter TNF levels. Most ultradiafiltrate samples (74%) contained demonstrable TNF (mean, 314 pg/ml; 95% CI: 67-561). Daily TNF excretion was a mean of 15.9 micrograms (+5.6 standard error [SE]), with a mean daily clearance of 27.5 L (95% CI: 2.5-52.5). The authors conclude that significant amounts of TNF are excreted in the ultradiafiltrate during CHD. This observation may provide a rationale for use of similar therapies in critically ill patients in the absence of conventional indications for dialytic support.
肿瘤坏死因子α（TNF）是危重病患者损伤的介质。其小分子大小（17kd）应使其在连续性血液透析滤过（CHD）过程中能够被清除。作者研究了12例接受CHD治疗的危重病患者（急性生理与慢性健康状况评分系统II [APACHE II]平均评分为26.3；范围为19 - 34）的TNF清除情况。在治疗0.4小时和24小时时，分别对预滤和滤过后的血液以及超滤液中的TNF水平进行了测量。在CHD治疗前，血浆TNF平均水平为261 pg/ml（95%置信区间[CI]：184 - 578），24小时后为291 pg/ml（95% CI：0 - 589）。预滤和滤过后的TNF水平之间无统计学显著差异。大多数超滤液样本（74%）含有可检测到的TNF（平均为314 pg/ml；95% CI：67 - 561）。每日TNF排泄量平均为15.9微克（标准误[SE]为+5.6），平均每日清除量为27.5 L（95% CI：2.5 - 52.5）。作者得出结论，在CHD过程中，大量TNF通过超滤液排出。这一观察结果可能为在没有透析支持常规指征的危重病患者中使用类似治疗方法提供了理论依据。
