Toft P, Nilsen B U, Bollen P, Lillevang S, Olsen K E, Brøchner A C, Larsen N H
Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
Acta Anaesthesiol Scand. 2007 Jul;51(6):679-86. doi: 10.1111/j.1399-6576.2007.01312.x.
Increased survival with high-volume continuous veno-venous haemofiltration (CVVH) has been demonstrated in critically ill patients. This may be the result of intensified blood purification or an effect on the immune system. We hypothesized that CVVH modifies the cell-mediated immunity. We investigated the effect of high-volume CVVH for 24 h on the cell-mediated immunity following endotoxin infusion.
Thirty pigs were divided into three groups. Ten pigs received 30 microg/kg of Escherichia coli endotoxin. These pigs were treated with CVVH (replacement 35 ml/kg/h) over the following 24 h. Ten pigs received the same bolus of endotoxin and ten pigs served as a control group. The adhesion molecules CD18, CD44 and CD62L and the ability to respond with an oxidative burst were measured. The number of neutrophils was counted in blood and lung tissue. The lymphoproliferative response and cytokines interleukin-6 and interleukin-10 were measured.
The infusion of endotoxin was followed by initial granulocytopenia and, later, granulocytosis, activation of CD18 and CD62L, and increased oxidative burst. The cytokine level was increased. CVVH had no effect on the adhesion molecules or cytokine level and did not reduce the number of granulocytes in the lung significantly. CVVH, however, reduced the oxidative burst activity of neutrophils after 2 h of treatment.
In the first few hours after endotoxaemia, high-volume CVVH reduced the oxidative burst activity of neutrophils. However, in the long term, CVVH was unable to modify the endotoxin-induced changes in cell-mediated immunity.
高容量连续性静脉-静脉血液滤过（CVVH）已被证实在危重症患者中可提高生存率。这可能是强化血液净化的结果，或是对免疫系统产生作用的结果。我们推测CVVH可改变细胞介导的免疫。我们研究了高容量CVVH持续24小时对内毒素输注后细胞介导免疫的影响。
30头猪被分为三组。10头猪接受30微克/千克的大肠杆菌内毒素。这些猪在接下来的24小时内接受CVVH治疗（置换量为35毫升/千克/小时）。另外10头猪接受相同剂量的内毒素推注，10头猪作为对照组。测量黏附分子CD18、CD44和CD62L以及氧化爆发反应能力。对血液和肺组织中的中性粒细胞进行计数。测量淋巴细胞增殖反应以及细胞因子白细胞介素-6和白细胞介素-10。
内毒素输注后最初出现粒细胞减少，随后出现粒细胞增多、CD18和CD62L活化以及氧化爆发增加。细胞因子水平升高。CVVH对黏附分子或细胞因子水平无影响，也未显著减少肺内粒细胞数量。然而，CVVH在治疗2小时后降低了中性粒细胞的氧化爆发活性。
在内毒素血症后的最初几个小时，高容量CVVH降低了中性粒细胞的氧化爆发活性。然而，从长期来看，CVVH无法改变内毒素诱导的细胞介导免疫变化。
