Lijun Ying, Tie Lyu, Jing Yan
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Sep;27(9):750-3.
To investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.
A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous venovenous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluation II (APACHE II) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.
The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9 ± 7.3)% vs. (26.4 ± 6.7)%, P > 0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9 ± 8.6)% vs. (29.3 ± 7.1)%, 5 days: (42.7 ± 9.2)% vs. (31.4 ± 6.5)%, 7 days: (40.9 ± 8.5)% vs. (29.4 ± 6.7)%, all P < 0.05]. There was no significant difference in APACHE II score before treatment between experimental group and control group (22.4 ± 5.3 vs. 21.7 ± 6.2, P > 0.05). APACHE II score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6 ± 3.6 vs. 20.5 ± 4.3, 5 days: 15.8 ± 3.9 vs. 21.1 ± 4.4, 7 days: 14.9 ± 4.2 vs. 19.8 ± 3.7, all P < 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3 ± 3.4 vs. 19.8 ± 3.7, t = 6.432, P = 0.003) and length of ICU stay (days: 20.7 ± 3.9 vs. 26.8 ± 4.7, t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%, χ2 = 3.121, P = 0.016).
Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.
探讨血液滤过联合血液灌流对人白细胞抗原DR（HLA-DR）表达低下的脓毒症患者免疫功能的改善作用。
进行一项前瞻性随机对照试验。纳入60例年龄超过18岁、HLA-DR表达低于30%的脓毒症患者，将其随机分为实验组和对照组，每组n = 30例。所有患者均采用脓毒症标准治疗方案，实验组在1 - 3天内加用血液滤过联合血液灌流。采用持续静静脉血液滤过（CVVH）模式，前稀释量为4 L/h，血液滤过器为HF2000，血液灌流器为HA-330H。分别于治疗前及治疗后3、5、7天测定外周血单个核细胞HLA-DR的表达。评估两组患者的急性生理与慢性健康状况评分系统II（APACHE II）评分、机械通气时间、重症监护病房（ICU）住院时间及28天生存率。
实验组和对照组治疗前HLA-DR表达均低于30%，差异无统计学意义[（25.9 ± 7.3）% vs.（26.4 ± 6.7）%，P > 0.05]。实验组治疗后3、5、7天HLA-DR表达逐渐升高，且显著高于对照组[3天：（38.9 ± 8.6）% vs.（29.3 ± 7.1）%，5天：（42.7 ± 9.2）% vs.（31.4 ± 6.5）%，7天：（40.9 ± 8.5）% vs.（29.4 ± 6.7）%；均P < 0.05]。实验组和对照组治疗前APACHE II评分差异无统计学意义（22.4 ± 5.3 vs. 21.7 ± 6.2，P > 0.05）。实验组治疗后3、5、7天APACHE II评分逐渐降低，且明显低于对照组（3天：18.6 ± 3.6 vs. 20.5 ± 4.3，5天：15.8 ± 3.9 vs. 21.1 ± 4.4，7天：14.9 ± 4.2 vs. 19.8 ± 3.7；均P < 0.05）。与对照组相比，实验组机械通气时间（天：13.3 ± 3.4 vs. 19.8 ± 3.7，t = 6.432，P = 0.003）和ICU住院时间（天：20.7 ± 3.9 vs. 26.8 ± 4.7，t = 5.452，P = 0.006）显著缩短，28天生存率显著提高（83.3% vs. 73.3%，χ2 = 3.121，P = 0.016）。
血液滤过联合血液灌流可提高HLA-DR低表达脓毒症患者的HLA-DR表达，在一定程度上改善脓毒症患者的免疫功能及预后。
