血液净化对脓毒症相关性脑病患者神经元特异性烯醇化酶水平的影响
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摘要
目的探讨血液净化对脓毒症相关性脑病(SAE)患者神经元特异性烯醇化酶(NSE)水平的影响。方法选择87例SAE患者为研究对象,根据是否使用床旁连续血液净化(CBP)分为对照组与观察组,对照组(45例)采用以重要器官支持治疗及原发病治疗为主的综合治疗,观察组(42例)在综合治疗基础上使用床旁CBP,分别在治疗前、治疗后12 h、24 h、72 h对患者血清NSE水平予以动态监测,并检测CD4~+/CD8~+、凝血相关因子(PT、APTT)及炎症因子(TNF-ɑ、IL-6)等水平。结果对照组1例死亡,观察组2例死亡;两组治疗后NSE水平均呈先上升后下降的趋势,观察组治疗后12 h明显高于治疗前,治疗后72 h明显低于治疗前,而对照组治疗后12 h、24 h明显高于治疗前,差异有统计学意义(P<0.05);不同时间点组间比较,治疗前两组NSE水平差异无统计学意义,治疗后12 h、24 h、72 h三个时间点,对照组NSE水平均明显高于观察组,组间差异均有统计学意义(P<0.05)。治疗后72 h时,两组CD4~+/CD8~+较治疗前均显著升高,PT、APTT、TNF-ɑ及IL-6水平较治疗前均显著下降,且观察组上升或下降幅度明显大于对照组,组间差异均有统计学意义(P<0.05)。结论血液净化可显著调节脓毒症相关性脑病患者免疫功能,降低炎性反应,显著降低血清NSE水平,减轻神经损伤,促进机体整体康复。
Objective To investigate the influence of blood purification on neuron-specific enolase(NSE) level in patients with septic associated encephalopathy(SAE).Methods 87 cases of SAE were selected as study objects,and they were divided into two groups according to whether they use bedside continuous blood purification(CBP) or not,45 cases in control group were given comprehensive treatment based on important organ support treatment and primary diseases treatment,and 42 cases in observation group were given bedside CBP on the basis of the control group.And then,serum NSE levels of patients before treatment and 12 h,24 h and 72 h after treatment were dynamically monitored,and CD4~+/CD8~+,coagulation related factors(PT,APTT) and inflammatory factors(TNF-ɑ,IL-6) were detected.Results 1 case died in the control group and 2 cases died in the observation group.After treatment,NSE levels in both groups increased first and then decreased.12 h after treatment,the NES level in the observation group was significantly higher than that before treatment,and it was significantly lower at 72 h after treatment than that before treatment,while in the control group at 12 h and 24 h after treatment,the level was significantly higher than that before treatment,difference was statistically significant(P<0.05).There was no statistically significant difference in NSE levels between the two groups at different time points before treatment.At 12 h,24 h and 72 h after treatment,the NSE levels of the control group were significantly higher than those of the observation group,and difference between the two groups was statistically significant(P<0.05).At 72 h after treatment,the levels of CD4~+/CD8~+ in the two groups were significantly higher than those before treatment,and the levels of PT,APTT,TNF-ɑ and IL-6 were significantly lower than those before treatment,and the increase or decrease in the observation group was significantly greater than that in the control group,difference between the two groups was statistically significant(P<0.05).Conclusion Blood purification can significantly regulate immunologic function of patients with SAE,lower inflammatory reaction and serum NSE level,relieve nerve injury,and promote integral rehabilitation.
Objective To investigate the influence of blood purification on neuron-specific enolase(NSE) level in patients with septic associated encephalopathy(SAE).Methods 87 cases of SAE were selected as study objects,and they were divided into two groups according to whether they use bedside continuous blood purification(CBP) or not,45 cases in control group were given comprehensive treatment based on important organ support treatment and primary diseases treatment,and 42 cases in observation group were given bedside CBP on the basis of the control group.And then,serum NSE levels of patients before treatment and 12 h,24 h and 72 h after treatment were dynamically monitored,and CD4~+/CD8~+,coagulation related factors(PT,APTT) and inflammatory factors(TNF-ɑ,IL-6) were detected.Results 1 case died in the control group and 2 cases died in the observation group.After treatment,NSE levels in both groups increased first and then decreased.12 h after treatment,the NES level in the observation group was significantly higher than that before treatment,and it was significantly lower at 72 h after treatment than that before treatment,while in the control group at 12 h and 24 h after treatment,the level was significantly higher than that before treatment,difference was statistically significant(P<0.05).There was no statistically significant difference in NSE levels between the two groups at different time points before treatment.At 12 h,24 h and 72 h after treatment,the NSE levels of the control group were significantly higher than those of the observation group,and difference between the two groups was statistically significant(P<0.05).At 72 h after treatment,the levels of CD4~+/CD8~+ in the two groups were significantly higher than those before treatment,and the levels of PT,APTT,TNF-ɑ and IL-6 were significantly lower than those before treatment,and the increase or decrease in the observation group was significantly greater than that in the control group,difference between the two groups was statistically significant(P<0.05).Conclusion Blood purification can significantly regulate immunologic function of patients with SAE,lower inflammatory reaction and serum NSE level,relieve nerve injury,and promote integral rehabilitation.
引文
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[11] Olivecrona Z,Bobinski L,Koskinen LO.Association of ICP,CPP,CT findings and S-100B and NSE in severe traumatic head injury.Prognostic value of the biomarkers[J].Brain Injury,2015,29(4):446-454.
[12] Tauber SC,Eiffert H,Brück W,et al.Septic encephalopathy and septic encephalitis[J].Expert review of anti-infective therapy,2017,15(2):121-132.
[13] 曹昉,冷彦飞,严斌,等.脓毒血症AKI患者采用CRRT治疗的临床疗效[J].临床和实验医学杂志,2015,14(14):1196-1198.
[2] 项丹,曾其毅.脓毒症相关性脑病发病机制研究进展[J].中国实用儿科杂志,2015,30(7):550-555.
[3] 叶向红,彭南海,江方正,等.脓毒症病人血液净化联合早期肠内营养的耐受性管理[J].肠外与肠内营养,2016,23(1):44-47.
[4] Dellinger RP,Levy MM,R hodes A,et al.Surviving sepsis campaign:international guidelines for management of severesepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[5] Ebersoldt M,Sharshar T,Annane D.Sepsis-associated delirium[J].Intensive Care Med,2007,33(6):941-950.
[6] 周瑞祥,翁方中,戴伟,等.严重脓毒症早期应用连续性血液净化的时机及其器官保护作用:一项随机双盲对照研究[J].中华危重病急救医学,2016,28(3):241-245.
[7] 张晨美,朱益飞.连续血液净化在儿童严重脓毒症中的应用[J].中华实用儿科临床杂志,2015,30(6):412-415.
[8] 戴喜明,高青豹,胡清甫.醒脑静注射液联合床旁高流量持续血液净化治疗脓毒性休克48例临床分析[J].重庆医学,2016,45(14):1978-1980.
[9] 何群鹏,谢红浪.血液净化技术在中毒患者治疗中的应用[J].肾脏病与透析肾移植杂志,2015,24(4):381-385.
[10] 徐伟华,赵冬,戴晶,等.神经元特异性烯醇化酶在神经元氧糖剥夺损伤模型复氧后的表达变化[J].中国全科医学,2015,18(20):2444-2447.
[11] Olivecrona Z,Bobinski L,Koskinen LO.Association of ICP,CPP,CT findings and S-100B and NSE in severe traumatic head injury.Prognostic value of the biomarkers[J].Brain Injury,2015,29(4):446-454.
[12] Tauber SC,Eiffert H,Brück W,et al.Septic encephalopathy and septic encephalitis[J].Expert review of anti-infective therapy,2017,15(2):121-132.
[13] 曹昉,冷彦飞,严斌,等.脓毒血症AKI患者采用CRRT治疗的临床疗效[J].临床和实验医学杂志,2015,14(14):1196-1198.