连续性高容量血液净化对脓毒症多形核白细胞核转录因子、细胞间粘附因子-1、L-选择素表达水平的影响
孟玫1 王春亭1 张继承1 蒋进皎1 丁敏1 任宏生1 曾娟1 王鹏1 孟冲1
山东省立医院重症医学科
[摘要] 目的 连续性高容量血液净化治疗脓毒症病人，观察治疗前后多形核白细胞细胞核转录因子、细胞间黏附分子-1、L-选择素的变化。 方法25例脓毒症病人，行连续性高容量血液净化治疗，留取治疗前、治疗后（4h、12h）的血液，分离多形核白细胞，实时荧光定量RT-PCR检测多形核白细胞细胞核转录因子mRNA的表达，Western-blot检测多形核白细胞细胞间黏附分子-1、L-选择素蛋白的表达水平。结果 连续性高容量血液净化治疗后，脓毒症病人血液多形核白细胞细胞核转录因子mRNA表达水平下降（治疗前和治疗后4h、12h实时荧光定量 RT-PCR mRNA的相对表达量：1.23±0.57、0.61±0.39、0.56±0.35；n=25,P<0.05），连续性高容量血液净化治疗后，脓毒症病人血液多形核白细胞血管细胞黏附分子-1蛋白的表达水平下降（治疗前和治疗后4h、12h Western-blot积分吸光值： 0.83±0.42、0.54±0.30、0.27±0.14；n=25,P<0.05），多形核白细胞L-选择素的蛋白表达水平下降（治疗前和治疗后4h、12h Western-blot积分吸光值：0.96±0.74、0.63±0.46、0.51±0.43；n=25,P<0.05）。结论 连续性血液净化可能通过降低多形核白细胞细胞核因子的转录、抑制多形核白细胞细胞间黏附分子-1、L-选择素的表达，从而抑制脓毒症多行核白细胞的过度激活和趋化。
[关键词] 脓毒症；血液净化；多形核白细胞；核转录因子；细胞间黏附分子；L-选择素
Research into the effect of continuous high-dose blood purification on expression of NF-kappaB，ICAM-1 and L-selectin in polymorphonuclear leukocytes of sepsis patients
[Abstract] Objective Through investigating the change of nuclear factor- kappa B （NF-kappaB），intercellular adhesion molecule-1(ICAM-1) and L-selectin in polymorphonuclear leukocytes of sepsis patients who received early high dose continuous blood purification therapy, to explore the effects and find out its mechanism of early high-dose continuous blood purification on polymorphonuclear leukocytes in sepsis patients. Methods Twenty-five sepsis patients were treated with early high-dose continuous blood purification. Polymorphonuclear leukocytes were separated from blood and collected at different time(0, 4, 12h) respectively. Real-time fluorescent quantitative PCR was adopted to describe the expression of mRNA of NF-kappaB in polymorphonuclear leukocytes. Expression of protein of ICAM-1 and L-selectin in polymorphonuclear leukocytes was determined by Western-blot. The statistical analysis was performed using one-way ANOVA and student t test. Results Early high dose continuous blood purification therapy in sepsis patients led to a inhibition in the expression of mRNA of NF-kappaB in polymorphonuclear leukocytes (0h: 1.23±0.57、4h:0.61±0.39、12h:0.56±0.35；n=25,P<0.05). Early high dose continuous blood purification therapy in sepsis patients caused a decline in the expression of ICAM-1 (0h: 0.83±0.42、4h: 0.54±0.30、12h: 0.27±0.14；n=25,P<0.05), and at the same time it caused an decrease in the exprssion of L-selectin (0h: 0.96±0.74、4h: 0.63±0.46、12h: 0.51±0.43；n=25,P<0.05). Conclusions Early high dose continuous blood purification therapy may restrain the overactivation and decrease the ability of chemotaxis through inhibition of NF-kappaB，ICAM-1 and L-selectin in polymorphonuclear leukocytes of sepsis patients.
Key words Sepsis; continuous blood purification；polymorphonuclear leukocytes； Nuclear factor- kappa B; Intercellular adhesion molecule-1; L-selectin
